Spontaneous Nystagmus

• Cause:
– Lesion to peripheral vestibular system
• Imbalance of tonic signals sent to oculomotor
neurons from vestibular nuclei
• Causes a constant drift of the eyes in one direction
– Vestibular system thinks head is turning away from
lesioned side
– Eyes are pushed away from the side of the strongest
neural input until reach pre-established point where
they are interrupted and returned by the fast
component in the opposite direction
– If due to a peripheral lesion: pursuit system can cancel
(except in the ACUTE phase), by having patient open
eyes and fixate the nystagmus disappears
Spontaneous Nystagmus
– Peripheral vestibular lesions
• Cause diminished tonic afferent signals from all five
sensory organs of one labyrinth (3 ampullaris cristae
and both maculae)
– Resulting peripheral vestibular spontaneous nystagmus
has a combined torsional, horizontal and vertical
component
» Horizontal is most dominant component due to
tonic activity from vertical canals and otolith
organs partially canceling each other
– Spontaneous nystagmus post acute lesion (eyes open
and goes away with fixation) disappears 1-2 weeks post
acute peripheral lesion
Spontaneous Nystagmus
• Spontaneous nystagmus with eyes closed can be
found years later
– Can indicate incomplete compensation
– Peripheral lesion opposite to direction of
nystagmus
» Ex. Right beating spontaneous (vision
denied) uncompensated left peripheral
vestibular lesion
– Occasionally irritative lesions can give
spontaneous nystagmus toward side of the
lesion
» Ex. Meniere’s disease
 Spontaneous / Positional
Nystagmus
• Common Classification of unidirectional
nystagmus: 
– "1st degree is present only on looking in the
direction of the quick phases,
– 2nd degree is also present in the central
position;
– 3rd degree is present on looking in all
directions of gaze." 

Page 412 R. John Leigh and David S. Zee "The Neurology of Eye Movements" 3rd edition.
 Spontaneous / Positional
Nystagmus
• Let’s repeat that so it might be more
clear….
– "When the nystagmus is direction-fixed
(always beating in the same direction),
it may be characterized as either 1st,
2nd or 3rd degree. 
• If seen only in one position of lateral gaze
then it is called 1st degree;
• if seen in lateral gaze and in primary
position, then it is called 2nd degree;
• and if seen in primary and both lateral gaze
positions, it is called 3rd degree."

Shepard & Telian 1996

 Spontaneous / Positional
Nystagmus
• Why positional can exist with no
spontaneous?
– Past belief was lesions of otolith organs and
their connections in the vestibular nuclei and
cerebellum caused positional nystagmus
• Because these sensory organs are sensitive to
changes in direction of gravity
– More recent studies indicate the cupula is
altered so that its specific gravity no longer
equals that of the surrounding endolymph
• This causes the organ to become sensitive to
changes in direction of gravity and can produce
positional nystagmus
 Spontaneous / Positional
Nystagmus
• Why can positional nystagmus exist with
no spontaneous nystagmus? (continued)
– Evidence that both structural and metabolic
factors can alter the specific gravity of the
cupula and cause positional nystagmus
(Honrubia, 2000)
– So, positional nystagmus is generally a
manifestation of an organic pathology affecting
the vestibular system
 Spontaneous Nystagmus
• What is Significant?
– According to Dr. David Cyr (1991)
• Even when mild positional or spontaneous
nystagmus occurs in people without Sx
(normals)
– Note presence, direction and velocity in each
position regardless of how minimal the SCV is.
• If patient has a peripheral vestibular lesion
the spontaneous and/or positional
nystagmus is probably a sign of tonic
vestibular imbalance
– If both vestibular systems are equal, then
nystagmus should not be present
• Remember: patients that see us are not
“normal” or would not be in complaining of
imbalance/dizziness
 Analysis- Spontaneous
• Working data tab
– Clean up and
analyze data
• Windowed data tab
– Save a selection of
data for printing
• Loaded data tab
– Raw data

• When analyzing data

you can print the
screen
– Click print screen
button
– Additional way to
show data of
 Analysis- Spontaneous
• Filters
– Min. Delta
• removes all slow
phase components
(or any other
sloping waveform)
with a slope equal
to, or less than,
the current
setting.
 Analysis- Spontaneous
• Velocity limits filter
– remove all data outside max & min velocity limits
set on the scale.
• Adjust by dragging pointers up/down or
• clicking up/down arrows on the level indicators
at each end of the scale.
• Select Eye
– control data viewing/analyzing
• ‘Combined’: average response from the left and
right eye.
• ‘Both’: displays left and right responses
together on the same graph.
• “Right” or “Left” displays single eye data
 Analysis- Spontaneous
• Results (Index)
– Green cursor
indicates laser
on/off
– Results show the
average laser on
(fixation) eye
velocity (deg/sec)
for 1st segment &
average laser off
(vision denied)
eye velocity for 2nd
segment
– Use the index
 Analysis- Spontaneous
• Delete Area
– Click to display two
red cursor lines.
– Drag lines to section
of data to be
removed
– Click ‘Done’
– The deleted area will
be highlighted in red
and then removed
from the result
calculations.
• Delete undesired beats
by clicking on them
– The deleted velocity
beat will be
Analysis - Spontaneous
• Windowed Data Tab
– Will show the data
from Fixation and
Vision Denied in each
window
– If there is data you
wish to have in the
report or printed
• Select the area with
the Zoom option you
prefer and “Set
Window” for both
Fixation (laser on) and
Vision denied (laser
off)
– Will give ASPV
for each