Which finding is more typical of peripheral vertigo?

• A. Direction-changing nystagmus
• B. Vertical nystagmus
• C. Neuro signs
• D. Fatigable horizontal nystagmus

Answer: (D)

Peripheral vertigo typically shows a unidirectional, horizontal nystagmus that fatigues with time or with repeated testing and is reduced or suppressed by visual fixation. This pattern comes from an imbalance in input from one side’s vestibular apparatus (such as the inner ear or vestibular nerve) that the brain cannot fully sustain, so the nystagmus wanes as the system adapts. Because the issue is peripheral, you usually don’t see additional neurological signs and the nystagmus does not usually change direction with gaze. In contrast, vertical nystagmus, direction-changing nystagmus, and any accompanying neuro signs point more toward a central cause. Therefore, fatigable horizontal nystagmus is the classic finding that best fits peripheral vertigo.