Caloric eye-tracking pattern test: visual suppression and the possibility of simplified differential diagnosis between peripheral and central vertigo.

During the examination of patients who complain of vertigo or who have equilibrium disorders, often identifying the etiology of the disorders is difficult (i.e., determining whether it is dependent on a peripheral or a central vestibular disorder). To attempt to determine the etiology in these cases, we devised a new method: the caloric eye-tracking pattern test. In normal subjects and in patients with peripheral disorders, as is well-known, caloric nystagmus has little influence on the eye-tracking pattern. In contrast, in patients with central vestibular disorders, caloric nystagmus evoked abnormalities in the eye-tracking pattern, either superimposed or as saccades, despite the fact that the eye-tracking pattern before caloric stimulation was normal. These findings result from the visual suppression mechanism to vestibular nystagmus. We can conclude that the visual suppression to vestibular nystagmus is evoked more strongly by pursuing a moving visual stimulus than by gazing at a stationary target. These results are interesting, not only from the physiological viewpoint but from the clinical viewpoint. The differential diagnosis should include both peripheral and central vertigo.