Observation of positional nystagmus with infrared CCD camera

Using infrared CCD camera and electronystagmography we analyzed positional nystagmus in 33 patients with peripheral positional vertigo. Patients were classified into three types; (a) lateral type: nystagmus occurs in lateral position, (b) sagittal type: nystagmus occurs in head-hanging position (so-called benign paroxysmal positional vertigo, BPPV), and (c) mixed type. Nystagmus in the lateral type was horizontal and that in the sagittal type was rotatory. In all types, the vertigo and nystagmus began with a few seconds' latency after head tilt and briefly increased to a maximum, and then gradually decreased. The duration of horizontal nystagmus in the lateral and mixed type was significantly longer than that of rotatory nystagmus in the sagittal type mixed type. The mean value of the former was 90.6 s and that of the latter 18.1 s. We suggest that the velocity storage mechanism of the horizontal vestibulo-ocular reflex (VOR) is considerably different from that in the vertical VOR.