Vestibular System Practice Test

Which sign is most consistent with a peripheral vestibular lesion?

Spontaneous nystagmus that persists with fixation Direction-changing nystagmus with gaze Unidirectional, fatigable nystagmus with no skew deviation Bilateral symmetric caloric response

Correct Answer:

Unidirectional, fatigable nystagmus with no skew deviation

Explanation:

A peripheral vestibular lesion tends to produce a nystagmus that is unidirectional, fatigable, and without skew deviation. When one labyrinth is affected, the eye movement pattern beats in a single direction toward the healthy ear; this nystagmus often fatigues over time as the system adapts. The absence of a skew deviation means there isn’t a vertical misalignment pointing to brainstem or central involvement. In contrast, central patterns often show direction-changing nystagmus with gaze or spontaneous nystagmus that persists with fixation, and bilateral symmetric caloric responses suggest bilateral or central issues rather than a unilateral peripheral problem. So the described unidirectional, fatigable nystagmus with no skew deviation best fits a peripheral lesion.

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