Spontaneous downbeat nystagmus (DBN) is the most common form of acquired nystagmus, characterized by a slow upward ocular drift and a corrective downward quick phase. The pathophysiology involves a final common pathway leading to decreased inhibition of the superior vestibular nucleus, often secondary to lesions in the flocculonodular lobes (flocculus/paraflocculus, FL/PFL), the paramedian tract (PMT), or the dorsal...
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Discussion
Signed responses from readers of the wire.
This case-based review offers a useful clinical framework for diagnosing downbeat nystagmus; audiologists and vestibular specialists performing videonystagmography or ocular-motor testing may refine their differential diagnosis approach, though the article is a single case review and not a practice-changing guideline.
Downbeat nystagmus is the most common form of acquired nystagmus and frequently presents to vestibular audiology and neuro-otology clinics, making awareness of its pathophysiology and diagnostic approach practically relevant.
- 01Downbeat nystagmus is the most common type of acquired nystagmus and has multiple neurological causes.
- 02The article presents a case-based diagnostic approach to pathophysiology and clinical workup.
- 03Published in Arquivos de Neuropsiquiatria (2026); case-report level evidence.
- 04Relevant to audiologists performing ocular-motor and vestibular assessments.
- 05No new treatment evidence is presented; diagnostic framework is the primary contribution.
Downbeat nystagmus is the most common form of acquired nystagmus.
opinionpartially supported- PMID
- 42594882
- DOI
- 10.1055/s-0046-1827165.
- Journal
- Arquivos de Neuropsiquiatria
- Publication type
- case_report
- Evidence level
- 4
- Population
- Single clinical case presenting with spontaneous downbeat nystagmus
- Intervention
- Clinical and diagnostic evaluation of downbeat nystagmus
Primary outcomes
Pathophysiological understanding of downbeat nystagmus; Practical diagnostic approach to spontaneous downbeat nystagmus