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Here is a thorough, position-by-position analysis of the entire VNG (Videonystagmography) report for Sunita Gupta (66F, ID: CCDA00279), dated 09-Jun-2026.
VNG Report - Complete Position-by-Position Analysis
1. SACCADES
Horizontal Saccades (0.3 Hz)
| Parameter | Right Eye | Left Eye | Normal Range |
|---|---|---|---|
| Velocity | 374.34°/s | 450.73°/s | 150-700°/s |
| Precision | 87.78 | 67.67 | >80% |
| Latency | 300.00 ms | 272.94 ms | <250 ms |
Findings: Left eye precision is below normal (67.67 < 80). Latency in both eyes is mildly prolonged (normal < 250 ms). Right eye precision is borderline acceptable.
Horizontal Saccades (0.45 Hz)
| Parameter | Right Eye | Left Eye |
|---|---|---|
| Velocity | 413.59°/s | 585.92°/s |
| Precision | 82.56 | 73.72 |
| Latency | 350.48 ms | 321.90 ms |
Findings: Left eye precision again reduced (73.72). Latencies are notably prolonged at higher frequency - suggesting difficulty with rapid, accurate eye movements (saccadic dysmetria/inaccuracy).
Vertical Saccades (0.3 Hz)
| Parameter | Right Eye | Left Eye |
|---|---|---|
| Velocity | 292.71°/s | 319.64°/s |
| Precision | 85.18 | 81.87 |
| Latency | 353.85 ms | 356.92 ms |
Findings: Precision within normal limits bilaterally. Latency is significantly prolonged bilaterally (>250 ms), suggesting central pathway slowing affecting vertical saccades.
Vertical Saccades (0.45 Hz)
| Parameter | Right Eye | Left Eye |
|---|---|---|
| Velocity | 292.56°/s | 301.91°/s |
| Precision | 81.18 | 78.32 |
| Latency | 206.67 ms | 200.00 ms |
Findings: Latency improved at 0.45 Hz. Precision slightly reduced in left eye.
Saccade Summary: Bilateral prolonged latency and reduced precision (especially left eye) - indicative of central dysfunction possibly at the level of the brainstem/cerebellum or frontal eye fields.
2. SMOOTH PURSUIT
Horizontal Smooth Pursuit (0.2 Hz)
| Direction | Right Eye | Left Eye | Normal |
|---|---|---|---|
| Rightward Gain | 0.32 | 0.34 | >0.7 |
| Leftward Gain | 0.35 | 0.36 | >0.7 |
Horizontal Smooth Pursuit (0.4 Hz)
| Direction | Right Eye | Left Eye |
|---|---|---|
| Rightward Gain | 0.33 | 0.28 |
| Leftward Gain | 0.26 | 0.25 |
Vertical Smooth Pursuit (0.2 Hz)
| Direction | Right Eye | Left Eye |
|---|---|---|
| Upward Gain | 0.30 | 0.36 |
| Downward Gain | 0.29 | 0.38 |
Vertical Smooth Pursuit (0.4 Hz)
| Direction | Right Eye | Left Eye |
|---|---|---|
| Upward Gain | 0.18 | 0.19 |
| Downward Gain | 0.13 | 0.18 |
Findings: All smooth pursuit gains are severely reduced in all directions (H and V, both frequencies, both eyes). Normal gain should be >0.7; values here range from 0.13-0.36. This is a classic sign of central (cerebellar/brainstem) pathology. Age-related decline alone would not cause such a drastic bilateral reduction across all directions.
3. OPTOKINETIC TEST (OKN)
| Condition | Right Eye Gain | Left Eye Gain | Normal |
|---|---|---|---|
| Left-to-Right 10° | 0.93 | 0.91 | ~1.0 |
| Right-to-Left 10° | 0.98 | 0.91 | ~1.0 |
| Top-to-Bottom 10° | 0.98 | 1.11 | ~1.0 |
| Bottom-to-Top 10° | 1.03 | 1.02 | ~1.0 |
Fast Phase Direction: None recorded in any direction (all "-").
Findings: OKN gains are symmetric and essentially normal (0.91-1.11) in all four directions. No directional asymmetry. This is a reassuring finding and argues against a complete unilateral cortical or peripheral lesion.
4. NYSTAGMUS TESTS
Spontaneous Nystagmus - In Light
- Horizontal SPV: Absent bilaterally
- Vertical SPV: Absent bilaterally
- No fast phase, no amplitude recorded
Finding: No spontaneous nystagmus in light. NORMAL.
Spontaneous Nystagmus - In Dark
- All parameters: Absent bilaterally
Finding: No spontaneous nystagmus in dark. NORMAL.
High Frequency Head Shake
- All parameters: Absent bilaterally
Finding: No post-head-shake nystagmus. This argues against a significant unilateral peripheral vestibular loss.
Hyperventilation
- All parameters: Absent bilaterally
Finding: No hyperventilation-induced nystagmus. Normal.
5. GAZE TEST
With Fixation (5 positions: Center, Left, Up, Right, Down)
- All positions: SPV, Amplitude, Fast Phase Direction, Frequency = "-" (absent/not recorded)
Finding: No gaze-evoked nystagmus in any direction with fixation. NORMAL.
Without Fixation (5 positions: Center, Left, Up, Right, Down)
- All positions: SPV, Amplitude, Fast Phase Direction, Frequency = "-" (absent)
Finding: No gaze-evoked nystagmus without fixation either. NORMAL.
A key caveat: despite these readings showing no formal nystagmus parameters, the raw traces show significant eye movement variability (wide amplitude swings in raw waveforms), which could reflect poor fixation, cooperation issues, or background drift - these warrant careful clinical correlation.
6. POSITIONAL TESTS
Dix-Hallpike Right
| Position | Finding |
|---|---|
| Sit Head Right (initial) | No nystagmus |
| Supine Head Ext. & Right | Right eye: Vertical SPV 4.27°/s, Amplitude 4.35°, Frequency 1.25 Hz (Left eye: none) |
| Return to Sit (Head Right) | Left eye: Horizontal SPV -13.78°/s, Amplitude -3.81°, Frequency 0.89 Hz |
Interpretation: Positive Dix-Hallpike to the right - nystagmus in the head-hanging right position with a vertical component in the right eye and return nystagmus in the left eye. Pattern is consistent with Right Posterior Canal BPPV (geotropic vertical-torsional nystagmus on right Dix-Hallpike).
Dix-Hallpike Left
| Position | Finding |
|---|---|
| Sit Head Left (initial) | No nystagmus |
| Supine Head Ext. & Left | Right eye: Horizontal SPV -2.84°/s, Amp -2.39°; Vertical SPV 5.32°/s, Amp 3.59°, Fast Phase 236.38°, Freq 1.59 Hz; Left eye: Vertical SPV 5.81°/s, Amp 3.53°, Freq 0.79 Hz |
| Return to Sit (Head Left) | Left eye: Horizontal SPV -15.88°/s, Amp -3.90°, Freq 1.32 Hz |
Interpretation: Positive Dix-Hallpike to the left as well. The fast phase direction (236.38°) and the vertical/torsional pattern suggest Left Posterior Canal BPPV, or the possibility of a cupulolithiasis variant given persistent nystagmus. Bilateral Dix-Hallpike positivity suggests bilateral posterior canal BPPV or a central positional disorder.
Yacovino Test (Central BPPV Protocol)
| Position | Finding |
|---|---|
| Supine Begin | Both eyes: Significant nystagmus - Right: Horizontal SPV -11.76°/s, Vertical SPV -53.38°/s, Fast Phase 102.23°, Freq 2.67 Hz; Left: Horizontal SPV -23.15°/s, Vertical SPV -62.10°/s, Fast Phase 119.05°, Freq 2.79 Hz |
| Supine Head Ext. 90° | Left eye: Vertical SPV +14.65°/s, Amp 5.10°, Freq 1.21 Hz (Right eye: none) |
| Supine Head Flex 45° | Right eye: Horizontal SPV 3.35°/s, Amp 1.87°, Freq 0.97 Hz (Left eye: none) |
| Supine End | No nystagmus bilaterally |
Interpretation: The Yacovino maneuver is designed for anterior canal BPPV or central positional nystagmus. The presence of significant bilateral nystagmus at the beginning of the supine position with a predominantly downbeat/vertical fast phase (102-119°) is strongly suggestive of anterior canal BPPV or a central positional disorder (midline cerebellar lesion). The high SPV values (up to 62°/s) and bilateral nature raise concern for a central etiology.
McClure-Pagnini Test (Horizontal Canal BPPV)
| Position | Finding |
|---|---|
| Sit to Supine | No nystagmus |
| Right Lateral | Right eye: Horizontal SPV 6.10°/s, Amp 4.18°, Vertical SPV -5.77°/s, Amp -2.50°, Fast Phase 30.84°, Freq 1.88 Hz |
| Supine Head Neutral (1st) | No nystagmus |
| Left Lateral | Both eyes: Horizontal SPV -7.06°/s (R), -6.73°/s (L); Amp -2.41° (R), -2.07° (L); Freq 1.19 Hz (R), 1.27 Hz (L) |
| Supine Head Neutral (2nd) | No nystagmus |
Interpretation: Nystagmus in both lateral positions (right lateral and left lateral) with a horizontal fast phase. This is the typical pattern for Horizontal (Lateral) Canal BPPV. The fact that nystagmus was present in both lateral positions (geotropic pattern - toward the ground in both roll directions) suggests bilateral horizontal canal BPPV (canalithiasis type) or cupulolithiasis of the horizontal canal.
Head Position Tests
| Position | Finding |
|---|---|
| Yaw Right | Right eye: Horizontal SPV -6.93°/s, Amp -3.32°, Freq 1.23 Hz |
| Yaw Left | No nystagmus |
| Pitch Forward | No nystagmus |
| Pitch Backward | Both eyes: Complex - Right: H-SPV 1.60°/s, V-SPV 1.98°/s, Fast Phase 349.49°, Freq 2.42 Hz; Left: H-SPV -1.15°/s, V-SPV -17.45°/s, Amp -4.42°, Fast Phase 104.73°, Freq 2.43 Hz |
| Roll Right | Right eye: Vertical SPV -3.96°/s, Amp -1.90°, Freq 0.92 Hz |
| Roll Left | Both eyes: H-SPV -8.42°/s (R), -8.32°/s (L); V-SPV +4.83°/s (R), +5.24°/s (L); Fast Phase 217.69° (R), 217.98° (L); Freq 1.95 Hz (R), 2.21 Hz (L) |
Interpretation:
- Yaw Right: Nystagmus in right ear-down position only - could reflect right horizontal canal involvement.
- Pitch Backward: Bilateral nystagmus with fast phase near 350° (right eye) and 104° (left eye) - predominantly vertical, suggests posterior/anterior canal involvement or central positional nystagmus with head extension.
- Roll Right: Mild vertical nystagmus in right eye only.
- Roll Left: Bilateral nystagmus with combined horizontal and vertical components, fast phase at ~218° - suggests left anterior canal or central etiology.
7. SUBJECTIVE VISUAL VERTICAL (SVV)
| Trial | Deviation | Direction |
|---|---|---|
| Clockwise - Trial 1 | 0° | Clockwise |
| Clockwise - Trial 2 | -1° (Left) | Clockwise |
| Anticlockwise - Trial 1 | -1° (Left) | Anticlockwise |
| Anticlockwise - Trial 2 | -1° (Left) | Anticlockwise |
| Blank BG - Trial 1 | 0° | Clockwise |
| Blank BG - Trial 2 | 0° | Clockwise |
Normal SVV range: within ±2.5°
Finding: All deviations are within ±1° - SVV is NORMAL. This argues against significant utricle dysfunction or an acute unilateral otolithic lesion.
Overall Summary & Interpretation
| Domain | Finding | Significance |
|---|---|---|
| Saccades | Prolonged latency, reduced precision (left > right) | Possible central (brainstem/frontal lobe) dysfunction |
| Smooth Pursuit | Severely reduced gain all directions, both eyes | Strong indicator of central (cerebellar/brainstem) pathology |
| OKN | Normal, symmetric | Reassuring - no major unilateral cortical/peripheral deficit |
| Spontaneous Nystagmus | Absent | Normal |
| Gaze Nystagmus | Absent | Normal |
| Head Shake / Hyperventilation | Absent | Normal |
| Dix-Hallpike (Right) | Positive - Vertical nystagmus on right | Right Posterior Canal BPPV |
| Dix-Hallpike (Left) | Positive - Vertical/torsional nystagmus on left | Left Posterior Canal BPPV |
| Yacovino Test | Positive with high-velocity downbeat nystagmus | Anterior canal BPPV or Central positional disorder |
| McClure-Pagnini | Positive bilaterally (horizontal nystagmus) | Bilateral Horizontal Canal BPPV |
| Head Position Tests | Multiple positions positive | Multicanal / central involvement |
| SVV | Normal (within ±1°) | No utricular lesion |
Clinical Impression
This VNG profile in a 66-year-old female reveals two distinct patterns:
-
Peripheral vestibular component (BPPV): Multiple positional tests are positive - Dix-Hallpike bilaterally, McClure-Pagnini bilaterally, and head position tests. The pattern suggests multicanal BPPV (possibly involving bilateral posterior canals and bilateral horizontal canals simultaneously), which is uncommon but recognized, particularly post-head trauma, in elderly patients, or following vestibular neuritis.
-
Central vestibular component (suspected): The severely reduced smooth pursuit gain in all directions, prolonged saccadic latency, the pattern of the Yacovino test (high-velocity vertical nystagmus in the supine position), and direction-changing positional nystagmus across multiple head positions collectively point to possible central vestibular dysfunction (cerebellar or brainstem). The normal SVV and absent spontaneous nystagmus do not exclude a central lesion.
Recommended next steps:
- MRI brain with contrast (posterior fossa focus) to rule out cerebellar or brainstem lesion
- Canalith repositioning maneuvers (Epley/BBQ roll) for BPPV canals identified
- Neurological consultation given the central features
- Consider caloric or vHIT testing to further quantify peripheral vestibular function per canal
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