It is described by the direction of the fast phase
When occurring as a result of a peripheral lesion, e.g. acute vestibular neuronitis, it is reduced by fixation and is associated with symptoms of vertigo
Downbeat nystagmus indicates a medullary-cervical junction lesion
Causes of multidirectional gaze-evoked nystagmus include multiple sclerosis and excess anti-epileptic medication.
Pendular nystagmus is caused by an inability to fixate, commonly congenital blindness.
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