🚨Nystagmus doesn’t suppress with fixation? It’s likely due to brain pathology! (A long case, but stay with me) This patient experienced a sudden onset of dizziness and hearing loss and was diagnosed with labyrinthitis. Imaging was normal, and he was referred to ENT for hearing loss care and vestibular therapy for eval and treat of vertigo and imbalance. Vestibular PT evaluation revealed central findings: ‼️ Direction-changing nystagmus with gaze ‼️ Vertical skew deviation ‼️ Unilateral pupillar

👀 Subtle spontaneous nystagmus? The head-shaking test is an essential clinical tool. This patient presented with mild vestibular symptoms, and spontaneous nystagmus was barely visible on initial inspection. After performing the head-shaking test (20 cycles at approximately 2 Hz), we were able to accentuate the underlying nystagmus, making it significantly easier to identify the pattern and laterality. 🔍 Why does this work? Head shaking fatigues the velocity storage mechanism and unmasks asymme