Downward rotational nystagmus

Downbeating and rotational nystagmus occurring with the Dix Hallpike test is indicative of anterior canal involvement for the downward facing side.  The evidence for treatment and diagnosis of the anterior canal is not strong as the posterior canal, as it traditionally thought to be infrequently involved. This leads to weak clinical evidence for treatment.   (Herdman S. J., 2007).  

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As stated previously it is important to consider the rotational component when diagnosing the affected ear, as both testing positions have potential to produce nystagmus, regardless of affected side.  (Herdman S. J., 2007).  

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Vertical component may increase with gaze (Brantberg & Bergenius, 2002).  Therefore, it may be beneficial for the clinician to instruct the patient not to focus gaze when assessing nystagmus.  

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