Spontaneous and positional nystagmus: a reassessment of clinical significance

The incidence of spontaneous and types of positional nystagmus in 302 patients with end organ, nerve, brain stem and cerebellar lesions is analyzed. All types of these nystagmus are frequently encountered in peripheral and central lesions. By itself the type of vestibular nystagmus (except vertical spontaneous seen in this series in only central lesions) is not diagnostic of any lesion. It should be considered with other findings. Based on these findings, the discontinuation of the term benign paroxysmal nystagmus is suggested. In a small number of cases retested over a year, a change from spontaneous to positional to paroxysmal positional nystagmus is shown. These changes are considered to reflect the degrees of vestibular compensation that occur over a period of time.