Central · refer

Direction-changing (gaze-evoked)

The fast phase reverses with gaze — central until proven otherwise.

Live · Gaze holding
Stylised teaching animation, exaggerated for visibility — not a recording of a real patient, and not a diagnosis.
Localises toCentral
Bedside testGaze holding
Fast phaseHorizontal, reverses with gaze
Reading

As the eyes move, the fast phase changes direction (right-beating on right gaze, left-beating on left gaze). In acute continuous vertigo this is a central sign — part of the dangerous HINTS pattern.

Direction-changing means the fast phase follows gaze: right-beating on right gaze, left-beating on left gaze. In a patient with acute, continuous vertigo that reversal is central, and it is the finding the N of HINTS looks for specifically — a beat that changes direction across gaze (Kattah 2009).

The contrast is with a peripheral vestibular nystagmus, which keeps ONE direction in every gaze position and only changes in intensity (Alexander's law). Direction that CHANGES is central; direction that merely STRENGTHENS toward the fast phase is peripheral — one of the highest-yield distinctions at the bedside.

Source: HINTS exam (Kattah 2009); Leigh & Zee.

Practice this in the trainerPlay today’s case

Other signs

Ocular tilt reaction

Alternate cover test + head posture

Pure downbeat

Positional / primary gaze

Head impulse — normal

Head impulse (thrust)
Stylised teaching animations authored by NeuroDash. Not real-patient recordings, not board-certified, and not reviewed by an outside specialist. Educational only — not medical advice and not a diagnosis.