With central causes of acute vestibular syndrome, it is not uncommon for the nystagmus to have a gaze-evoked component due to failure of gaze-holding circuits in the cerebellum or brainstem. In such instances, the nystagmus may reverse direction when the patient looks in the direction of the slow phase (Video 2b—direction-changing nystagmus; spontaneous left-beating nystagmus in primary and left gaze with reversal in right gaze in a patient with acute cerebellar infarction). Video 2a/b links to the open-access web site NOVEL (Neuro-Ophthalmology Virtual Education Library).
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