Physical examination maneuver

Physical Exam

Nystagmus Characterization

🎬
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 (nystagmus is named for its fast phase), whether it is present at rest or only on gaze, whether it changes direction with the direction of gaze, and whether covering the fixating eye or removing fixation changes it.

How to Interpret

Showing 0 of 2 findings
This test’s findings are all below your current evidence filter.

References

  • Gottlieb M, Peksa GD, Carlson JN. Head impulse, nystagmus, and test of skew examination for diagnosing central causes of acute vestibular syndrome. Cochrane Database Syst Rev. 2023 Nov 2;11(11):CD015089. doi:10.1002/14651858.CD015089.pub2. PMID 37916744. PMC10620998. Cochrane diagnostic-test-accuracy review; bivariate pooling; composite estimate from the 8-study advanced-imaging-reference subgroup (n=1146).
  • Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
  • Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Related Bedside Tests

🎬Video coming Sept 2026
Alternate Cover Test (Test of Skew)
aka Cross-cover test
Rule in:IEPeripheral Vestibular Dysfunction, IEPosterior Circulation Stroke
Rule out:IEPeripheral Vestibular Dysfunction, IEPosterior Circulation Stroke
🎬Video coming Sept 2026
Head Impulse Test
aka Head thrust test; Halmagyi test
Rule in:HPosterior Circulation Stroke, SHPeripheral Vestibular Dysfunction
Rule out:HPeripheral Vestibular Dysfunction, HPosterior Circulation Stroke
🎬Video coming Sept 2026
HINTS Exam
Rule in:IEPeripheral Vestibular Dysfunction, IEPosterior Circulation Stroke
Rule out:IEPeripheral Vestibular Dysfunction, IEPosterior Circulation Stroke
🎬Video coming Sept 2026
Dix-Hallpike Maneuver
Rule in:IECentral Vestibular Lesion, IEPosterior Canal BPPV
Rule out:IECentral Vestibular Lesion, IEPosterior Canal BPPV
🎬Video coming Sept 2026
Pupillary Light Reaction
Rule in:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more
Rule out:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more
🎬Video coming Sept 2026
Gait Assessment
Rule in:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more
Rule out:IEAcute Neurologic Event or Severe Pain, IEAlcohol-related Cerebellar Degeneration, IEBilateral Hip Arthritis or Disease +20 more