Perceptual and nystagmic thresholds of vestibular function in yaw

A technique for simultaneous measurement of conscious (perceptual) and reflex (nystagmus) thresholds of vestibular function is described. We used an automated modified binary search algorithm with simultaneous infrared oculography in determining perceptual and VOR nystagmic thresholds respectively, during discrete whole body rotations in the dark. In a young group of 14 normal subjects (mean age 23 years) angular acceleration thresholds were significantly higher for perceptual detection (1.18 deg/s/s) than for nystagmus generation (0.51 deg/s/s). Only nystagmic thresholds were slightly raised (0.87 deg/s/s) in an older group of 9 normal subjects (mean age 63 years). The finding that nystagmic thresholds are lower than perceptual ones indicates a higher sensitivity of brainstem than cortical vestibular mechanisms. This technique would be of particular value in clinical situations where a dissociation between reflex and conscious vestibular mechanisms is expected, e.g. in patients with cortical lesions or in elderly patients with falls.