kindly give the exact diagnosis and full reporting,pateint is having severe vertigo while moving his neck also
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VNG videonystagmography interpretation cervicogenic vertigo head position nystagmus diagnosis
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I now have a complete picture of the VNG report and the relevant clinical context. Let me compile the full report and diagnosis.
VNG Report - Full Interpretation & Diagnosis
Patient: Madhu Malik | Age: 37 | Gender: Female
Test Date: 01 July 2026 | ID: CCDA00282
Clinic: Priority Hearing Care Pvt Ltd
Report Type: Videonystagmography (VNG)
Complete Test-by-Test Findings
1. Saccades (Rapid Eye Movements)
| Parameter | 0.3 Hz Horizontal | 0.45 Hz Horizontal | 0.3 Hz Vertical | 0.45 Hz Vertical |
|---|---|---|---|---|
| Velocity (R/L) | 521/578 °/s | 531/470 °/s | 270/308 °/s | 365/339 °/s |
| Precision (R/L) | 90.9 / 91.5 | 94.9 / 96.4 | 64.6 / 62.5 | 76.1 / 74.7 |
| Latency (R/L) | 349/352 ms | 334/330 ms | 253/203 ms | 215/214 ms |
Interpretation: Horizontal saccades - velocity, precision, and latency are within normal limits bilaterally. Vertical saccade precision is mildly reduced (64-76%) but velocity and latency are acceptable. No significant saccade abnormality detected. This argues against central pathway (cerebellar/brainstem) disease.
2. Smooth Pursuit
| Direction | Frequency | Right Eye Gain | Left Eye Gain |
|---|---|---|---|
| Horizontal | 0.2 Hz | 0.94 / 0.94 | 0.94 / 0.90 |
| Horizontal | 0.4 Hz | 0.68 / 0.68 | 0.79 / 0.80 |
| Vertical (Up/Down) | 0.2 Hz | 0.96 / 0.70 | 0.97 / 0.72 |
| Vertical (Up/Down) | 0.4 Hz | 0.65 / 0.61 | 0.72 / 0.66 |
Interpretation: Low-frequency (0.2 Hz) horizontal pursuit is normal (gain ~0.94). High-frequency (0.4 Hz) horizontal pursuit shows a mild gain reduction (0.68-0.80), which is a normal age-appropriate degradation with increasing frequency. Vertical downward pursuit gain is mildly reduced (0.61-0.72) but not significantly pathological at 0.4 Hz. Overall smooth pursuit: essentially normal. No central smooth pursuit failure.
3. Optokinetic Testing (OKN)
| Stimulus | Gain RE | Gain LE | Fast Phase Direction |
|---|---|---|---|
| Left-to-Right 10° | 0.96 | 0.94 | None (absent) |
| Right-to-Left 10° | 0.97 | 0.98 | 152.6° / 159.4° |
| Top-to-Bottom 10° | 1.15 | 1.11 | None (absent) |
| Bottom-to-Top 10° | 0.99 | 1.00 | None (absent) |
Interpretation: OKN gain is symmetric and within normal range in all directions (0.94-1.15). The absence of fast phase direction in most conditions and the normal gain symmetry indicates no asymmetric central or peripheral OKN abnormality. OKN: Normal.
4. Spontaneous Nystagmus (Light and Dark)
- In Light: No nystagmus (SPV = -, Amplitude = -, no fast phase)
- In Dark: No nystagmus (SPV = -, Amplitude = -)
Interpretation: No spontaneous nystagmus in light or dark. This rules out active acute peripheral vestibular lesion (e.g., acute vestibular neuritis) and argues against significant ongoing uncompensated vestibular asymmetry.
5. Head-Shake Nystagmus (High Frequency)
| Parameter | Right Eye | Left Eye |
|---|---|---|
| Horizontal SPV | - | -5.03 °/s |
| Horizontal Amplitude | - | -3.00° |
| Vertical SPV | +6.14 °/s | - |
| Vertical Amplitude | 4.65° | - |
| Frequency | 0.55 Hz | 0.70 Hz |
Interpretation: Post-head-shake nystagmus is PRESENT - both horizontal (left-beating, left eye SPV ~5 °/s) and a vertical component (right eye). Head-shake nystagmus beating to one side after horizontal head shake indicates peripheral vestibular asymmetry, suggesting unilateral or asymmetric vestibular hypofunction. This is a key positive finding. The vertical component may indicate a small central contribution or a canal-specific labyrinthine asymmetry.
6. Hyperventilation Nystagmus
- Vertical SPV: Right eye 1.21 °/s, Left eye 1.04 °/s
- Amplitude: -0.51° / 1.52°
- Frequency: 0.88 / 0.95 Hz
Interpretation: Low-amplitude vertical nystagmus on hyperventilation is present. Hyperventilation-induced nystagmus can be seen with demyelinating lesions (e.g., MS), acoustic neuroma/schwannoma, or as a non-specific finding in vestibular dysfunction. The SPV (~1 °/s) is low but present.
7. Valsalva Nystagmus
- Valsalva glottic: No nystagmus
- Valsalva nose and mouth: Vertical SPV right eye = 6.19 °/s, Amplitude 2.63°, Frequency 1.11 Hz
Interpretation: Valsalva (nose/mouth)-induced nystagmus is PRESENT on the right side (vertical component). Valsalva-induced nystagmus can suggest a perilymphatic fistula, superior semicircular canal dehiscence (SSCD), or increased intracranial pressure affecting the labyrinth. This is a clinically significant finding requiring correlation.
8. Gaze Testing (Center, Left, Right, Up, Down - With & Without Fixation)
- All gaze positions with and without fixation: No nystagmus (SPV = -, Amplitude = -, Frequency = -)
Interpretation: No gaze-evoked nystagmus in any direction. This strongly argues against cerebellar or central brainstem pathology. No direction-changing gaze nystagmus, no rebound nystagmus. Central oculomotor pathways intact.
9. Dix-Hallpike Testing (BPPV Screen)
Dix-Hallpike Right (Posterior Canal Right BPPV test):
- Sit Head Right: No nystagmus
- Supine Head Extended & Right: Vertical SPV = -4.95 °/s (right eye), Amplitude -1.31°, Frequency 1.41 Hz
Dix-Hallpike Left (Posterior Canal Left BPPV test):
- Sit Head Left: No nystagmus
- Supine Head Ext. & Left: No nystagmus (SPV = -)
Interpretation: A weak but present nystagmus is detected in the Dix-Hallpike Right Supine position (SPV ~5 °/s on right eye). However, the nystagmus is low amplitude and not clearly geotropic/apogeotropic in the classic sense for posterior canal BPPV. It may represent a mild positional response. Classic BPPV pattern is NOT firmly established from this data alone (it would need subjective report of rotational vertigo with this maneuver and observation of upbeat-torsional nystagmus). This finding is suggestive but not conclusive for right posterior canal BPPV.
10. Supine Straight Head Extension
| Position | Horizontal SPV (R / L) | Amplitude (R / L) | Frequency |
|---|---|---|---|
| Supine (neutral) | -0.84 / -5.75 °/s | -1.09° / -2.41° | 0.67 / 0.87 Hz |
| Supine Head Ext. 90° | - / - | normal | - |
| Supine End | - / - | normal | - |
Interpretation: Horizontal nystagmus is present in the straight supine position - particularly in the LEFT eye (SPV -5.75 °/s, Amplitude -2.41°, Frequency 0.87 Hz). This is a left-beating horizontal nystagmus in the supine straight position. This pattern, specifically triggered by neck extension while supine, is a hallmark finding in cervicogenic/neck-proprioceptive vertigo and also in conditions affecting the posterior circulation (vertebrobasilar insufficiency). The nystagmus resolves on further head extension, which is relevant.
11. McClure-Pagnini (Horizontal Canal BPPV test)
- Sit to Supine: No nystagmus
- Right Lateral: No nystagmus
- Supine Head Neutral: No nystagmus (after right lateral)
- Left Lateral: No nystagmus
- Supine Head Neutral: No nystagmus (after left lateral)
Interpretation: No horizontal canal BPPV. The McClure-Pagnini (roll test) is entirely negative. This rules out horizontal (lateral) canal BPPV.
12. Head Position Tests (Yaw, Pitch, Roll)
| Position | Significant Finding? |
|---|---|
| Yaw Right | No nystagmus |
| Yaw Left | No nystagmus |
| Pitch Forward | No nystagmus |
| Pitch Backward | No nystagmus |
| Roll Right | No nystagmus |
| Roll Left | Horizontal SPV = +35.53 °/s, Amplitude 7.92°, Frequency 1.42 Hz (RIGHT eye!) |
Interpretation: This is the most striking finding in the entire report. A strong horizontal nystagmus (SPV 35.53 °/s, amplitude ~8°) is elicited specifically when the head is rolled to the LEFT. This is a direction-fixed horizontal nystagmus provoked by neck/head rotation - not present with roll to the right. This pattern is:
- NOT consistent with BPPV (which would require a geotropic or apogeotropic pattern seen equally in both lateral roll positions)
- Strongly consistent with cervicogenic vestibular dysfunction - proprioceptive input from cervical musculature and neck joints (especially C1-C3) feeding abnormal signals into the vestibular nuclei when the neck is rotated
- Also concerning for vertebrobasilar compression - vertebral artery compression during neck rotation (bow-hunter's syndrome or cervical spondylotic vertebral artery compression), which can cause positional nystagmus specifically with neck rotation
13. Subjective Visual Vertical (SVV)
| Condition | Deviation | Direction |
|---|---|---|
| Clockwise | 0° | Clockwise |
| Anticlockwise | -2° (Left tilt) | Clockwise |
| Blank Background | 0° | Clockwise |
Interpretation: SVV is essentially normal (within ±2.5° is generally accepted as normal). A -2° left tilt during anticlockwise rotation is borderline but within acceptable range. This largely excludes significant utricular otolith damage and major gravitational perception distortion.
DIAGNOSIS
Primary Diagnosis:
Cervicogenic Vestibular Dysfunction (Cervicogenic Vertigo/Dizziness)
This is the most consistent diagnosis given:
- The clinical history of vertigo triggered by neck movement - the defining feature of cervicogenic vertigo
- Strong horizontal nystagmus ONLY on Roll Left head position (SPV 35.53 °/s) - highly abnormal, provoked by neck/head rotation, not matching any BPPV canal pattern
- Horizontal nystagmus in supine straight with neck extension (Left eye SPV 5.75 °/s) - position-dependent, linked to neck posture
- Valsalva-induced nystagmus (right-side vertical, 6.19 °/s) - may reflect labyrinthine pressure changes aggravated by cervical/cranial vascular or structural dysfunction
- Post-head-shake nystagmus indicating peripheral vestibular asymmetry likely secondary to asymmetric neck afferent input
- No spontaneous nystagmus - no active acute peripheral lesion
- No Dix-Hallpike classical BPPV nystagmus - classical BPPV excluded
- Normal gaze testing - no central cerebellar/brainstem pathology
- Normal saccades and pursuit - no central oculomotor disease
- Normal McClure-Pagnini - horizontal canal BPPV excluded
Secondary Concern (Requires Vascular Evaluation):
Possible Vertebrobasilar Insufficiency / Cervical Spondylotic Vertebral Artery Compression
The unilateral roll-induced nystagmus (Roll Left >> Roll Right) with high SPV (35.53 °/s) in a 37-year-old female with neck-motion-triggered vertigo mandates ruling out vertebral artery compression or bow-hunter's syndrome, particularly if she has any history of cervical spondylosis, trauma, or connective tissue disorder.
What Has Been Excluded:
- Classic BPPV - Dix-Hallpike and McClure-Pagnini are negative / non-diagnostic
- Horizontal canal BPPV - Roll test (McClure-Pagnini) entirely normal
- Acute vestibular neuritis - No spontaneous nystagmus
- Meniere's disease - No progressive pattern, no significant caloric data suggesting fluctuating unilateral weakness noted in this report
- Central cerebellar pathology - Normal gaze, saccades, smooth pursuit, no direction-changing nystagmus
- Significant otolith dysfunction - SVV normal
Recommended Clinical Reporting (Impression for Clinician)
VNG Report Summary - Patient Madhu Malik, 37F, CCDA00282, 01-Jul-2026Ocular motility (saccades, smooth pursuit, OKN): Within normal limits. No evidence of central oculomotor dysfunction.Spontaneous nystagmus: Absent in both light and dark. No active peripheral vestibular lesion detected at rest.Head-shake nystagmus: Present - low-amplitude horizontal nystagmus post-head-shake (left eye SPV ~5 °/s) with a small vertical component. Suggests mild peripheral vestibular asymmetry, likely secondary to cervical afferent dysfunction.Gaze testing: No gaze-evoked nystagmus in any direction. No central gaze-holding abnormality.Positional testing:
- Dix-Hallpike Right: Weak positional response (SPV ~5 °/s) - non-diagnostic for classical posterior canal BPPV.
- Dix-Hallpike Left: Negative.
- McClure-Pagnini (Horizontal Canal BPPV): Negative bilaterally.
- Supine straight head extension: Horizontal nystagmus present (Left eye SPV 5.75 °/s) - positional nystagmus provoked by neck extension.
- Head position Roll Left: SIGNIFICANT ABNORMAL FINDING - Horizontal nystagmus with SPV 35.53 °/s and amplitude 7.92° provoked exclusively with left neck rotation. This is not consistent with labyrinthine BPPV.
Valsalva (nose/mouth): Vertical nystagmus present in right eye (SPV 6.19 °/s). Possible labyrinthine pressure-sensitive dysfunction.Hyperventilation: Low-amplitude vertical nystagmus (~1 °/s). Non-specific; low clinical significance in isolation.SVV: Essentially normal (within ±2°).Overall Impression: The VNG findings are not consistent with classical BPPV or active unilateral vestibular loss. The dominant pattern - strong horizontal nystagmus provoked specifically by left neck rotation (SPV 35.53 °/s), positional nystagmus on neck extension, and the clinical symptom of vertigo on neck movement - is most consistent with CERVICOGENIC VESTIBULAR DYSFUNCTION (CERVICOGENIC VERTIGO). Vertebrobasilar insufficiency secondary to cervical spondylosis or vertebral artery compression must be excluded by MRI/MRA cervical spine and vertebrobasilar vasculature.
Recommended Next Steps
- MRI Cervical Spine - assess for spondylosis, disc prolapse at C1-C5, foraminal narrowing
- MRA Vertebrobasilar System - rule out vertebral artery compression, basilar artery stenosis, or bow-hunter's syndrome
- Cervical X-ray with dynamic views (flexion/extension) - assess segmental instability
- Neurology/Neuro-otology referral for clinical correlation
- Vestibular physiotherapy with cervical rehabilitation once vascular cause is excluded
- Avoid provocative neck positions (especially left rotation) until vasculature is cleared
Sources: Cummings Otolaryngology Head and Neck Surgery (vestibular testing criteria, cervicogenic dizziness); Clinical VNG interpretation standards. Note: The impression and diagnosis must be correlated with the clinical history, neurological examination, and imaging findings by the treating physician.
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