Is vertigo always present with nystagmus?

From the Guidelines

No, vertigo is not always present with nystagmus. While these two conditions often occur together, particularly in vestibular disorders, they can exist independently of each other. Nystagmus refers to involuntary, rhythmic eye movements that can be caused by various factors including neurological issues, medication side effects, or congenital conditions that may not affect the balance system. Conversely, vertigo is a specific type of dizziness characterized by a sensation of spinning or movement that results from vestibular system dysfunction. Some forms of nystagmus, particularly those with central nervous system origins or congenital causes, may not produce any vertigo symptoms. Similarly, patients can experience vertigo without displaying observable nystagmus, especially if the vertigo is mild or intermittent. The relationship between these conditions depends on the underlying cause, with vestibular disorders like BPPV, Meniere's disease, and vestibular neuritis typically producing both symptoms, while other causes of nystagmus may not affect the balance system enough to trigger vertigo 1.

Key Points

• Nystagmus and vertigo can occur independently of each other
• Vestibular disorders like BPPV, Meniere's disease, and vestibular neuritis typically produce both nystagmus and vertigo
• Central nervous system origins or congenital causes of nystagmus may not produce vertigo symptoms
• Mild or intermittent vertigo may not be accompanied by observable nystagmus
• The underlying cause of nystagmus and vertigo determines their relationship 1

Clinical Implications

• Clinicians should consider the underlying cause of nystagmus and vertigo when diagnosing and treating patients
• A thorough medical history and physical examination are essential in determining the relationship between nystagmus and vertigo
• Patients with vestibular disorders should be evaluated for both nystagmus and vertigo, while those with central nervous system origins or congenital causes of nystagmus may require further evaluation to rule out vertigo 1

From the Research

Nystagmus and Vertigo

• Nystagmus is a common symptom associated with vertigo, but it is not always present with vertigo 2, 3.
• Vertigo can be caused by various conditions, including benign paroxysmal positional vertigo, Meniere disease, vestibular neuritis, and labyrinthitis 2.
• The diagnosis of vertigo can be challenging, and nystagmus can be a helpful indicator in determining the underlying cause 4, 5.

Relationship between Nystagmus and Vertigo

• Nystagmus can be used to differentiate between different inner-ear causes of dizziness, such as Meniere's disease, vestibular migraine, and benign paroxysmal positional vertigo 4.
• The characteristics of nystagmus, such as direction, duration, and slow phase velocity, can provide valuable information in diagnosing the underlying cause of vertigo 4, 5.
• However, not all cases of vertigo are associated with nystagmus, and other symptoms such as disequilibrium, presyncope, and lightheadedness can also be present 2, 3.

Clinical Evaluation of Nystagmus and Vertigo

• The evaluation of nystagmus is essential for the diagnosis of peripheral vestibular disorders, such as benign paroxysmal positional vertigo and vestibular neuritis 5.
• The HINTS (head-impulse, nystagmus, test of skew) examination can help distinguish peripheral from central etiologies of vertigo 3.
• Laboratory testing and imaging are not always required and are usually not helpful in diagnosing vertigo, except in cases where a central etiology is suspected 2, 3.