Three-dimensional analysis of spontaneous nystagmus in peripheral vestibular lesions

The direction of spontaneous nystagmus was recorded in three dimensions with scleral dual search coils in three patients after vestibular neurectomy and in seven patients with vestibular neuritis. The rotation vectors of the spontaneous nystagmus clustered along the sensitivity vector of the lateral semicircular canal (SCC). The direction of the spontaneous nystagmus after resection of the whole eighth nerve was not different from that after resection of only the superior branch of the vestibular nerve. Deviations from this direction were observed only after resection of the inferior vestibular nerve and in one patient with vestibular neuritis. The absence of nystagmus components in direction of the vertical SCC reflects an anisotropy of oculomotor efferents of the vestibulo—ocular reflex arc rather than alesion limited to the lateral SCC afferents. Therefore, the three-dimensional analysis of spontaneous nystagmus does not permit accurate localization of a peripheral vestibular lesion.