Table 1.
Normal standards and criteria used to analyze the vestibular tests and distinguish central vestibulopathy from peripheral vestibulopathy
| Vestibular tests | Normal vestibular examination | Peripheral vestibular examination | Central vestibular examination |
|---|---|---|---|
| Position nystagmus (Brandt-Daroff maneuver) | Absent | Present (rotatory, horizontal rotatory, and oblique) with latency, paroxysm, weariness, and vertigo | Present (vertical inferior, superior, rotatory, horizontal rotatory, and oblique), without latency, paroxysm, weariness, and vertigo |
| Calibration of the ocular movements | Regular | Regular | Irregular (alterations in latency, accuracy, and velocity of the saccadic movements) |
| Spontaneous nystagmus | Present (<7º/s) with closed eyes; absent with open eyes. | Present (>7º/s) with closed eyes; absent with open eyes. | Present with open eyes (vertical inferior, superior, rotatory, horizontal rotatory, oblique, cyclic, dissociated, and retractor) |
| Gaze nystagmus | Absent | Absent | Present, unidirectional, bidirectional, or mixed; presents a variety of nystagmus types |
| Oscillatory track | Types I and II | Type III | Type IV (pathognomonic); alterations of morphology and gain |
| Optokinetic nystagmus | Symmetrical, <20º/s | Asymmetrical, >20º/s, having superposed spontaneous nystagmus with open eyes that justifies this alteration | Asymmetrical, >20º/s, absent and reduced |
| Rotation test | >33%, after stimulation of the lateral and superior semicircular ducts | >33%, after stimulation of the lateral and superior semicircular ducts | >33%, after stimulation of the lateral and superior semicircular ducts and absence of induced oblique nystagmus |
| Air caloric test | Absolute value: Between 2º/s and 24º/s Relative values: Labyrinth preponderance <41% Nystagmus directional preponderance <36% | Absolute value: <2º/s (hyporeflexia), >24º/s (hyperreflexia) and areflexia Relative values: Labyrinth preponderance >41% Nystagmus directional preponderance >36% (Jongkees formula) | Absolute value: <2º/s (hyporeflexia), >24º/s (hyperreflexia) and areflexia Relative values: Labyrinth preponderance >41% Nystagmus directional preponderance >36% (Jongkees’ formula). Different nystagmus types may be observed: Dissociated, inverted, perverted, and absence of the fast component of the nystagmus |
| Inhibiting effect of ocular fixation | Present | Present | Absent |