Upbeating Rotational Nystagmus

Upbeat torsional nystagmus that occurs during the Dix Hallpike test is indicative of posterior canal involvement for the downward facing side.  Time the duration of the nystagmus, assess symptoms, and note if the onset is insidious or delayed. 



The torsional component may be increased with gaze to the involved side (Brantberg & Bergenius, 2002).