Physical examination maneuver
Physical Exam
Nystagmus Characterization
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Video coming September 2026
How to Perform
Observe the eyes with the patient looking straight ahead and then holding gaze to the right, left, up, and down (avoid extreme end-gaze, which can produce normal end-point nystagmus). Note whether involuntary oscillation is present, its plane (horizontal, vertical, torsional, or mixed), the direction of the fast phase, whether it is present at rest or only on gaze, and whether it changes direction with the direction of gaze.
How to Interpret
Showing 4 of 5 findings
Stroke
HINTS exam concerning (central pattern) in a patient with acute vestibular syndrome
Rule in
HelpfulDerived CI
Rule out
Very helpfulDerived CI
Evidence:Strong
Nystagmus present in a patient with confirmed acute ischemic stroke
Rule in
Very helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Limited
Vestibular Dysfunction
Purely vertical (down-beating or up-beating), purely torsional, or vertical-torsional spontaneous nystagmus
Rule in
Helpful
Rule out
Not helpful
Evidence:Strong
HINTS exam reassuring (peripheral pattern) in a patient with acute vestibular syndrome
Rule in
Very helpfulDerived CI
Rule out
HelpfulDerived CI
Evidence:Strong