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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Vertigo
David A. Froehling, Marc D. Silverstein, David N. Mohr, Charles W. Beatty
Origins of Nystagmus


Topics Discussed: pathologic nystagmus, vertigo

Excerpt: "The maintenance of the sense of balance and spatial orientation depends on input from the vestibular labyrinth, visual system, and proprioceptive nerves arising from tendons, muscles, and joints.9 The vestibular nuclei, which are in the medulla and lower pons, receive input from the vestibular labyrinth via the vestibular branch of cranial nerve VIII and from the cerebellum.10 The vestibular nuclei, in turn, send efferent fibers to the cerebellum, the medial longitudinal fasciculus, and the vestibulospinal tract. Visceral manifestations of vertigo (such as nausea and vomiting) are caused by altered input to the dorsal nucleus of the vagus nerve from the vestibular nuclei. Conscious awareness of vertigo resides in the superior temporal gyrus of the cerebral cortex9 and involves a mismatch between input to the cerebral cortex from the visual, proprioceptive, and vestibular systems.11 Lesions in various locations, including the inner ear, brain stem, and cerebellum, may all be manifested as vertigo...."
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