Execution
- 1Position the patient sitting and ask the patient to keep the head still.
- 2Hold a visual target at a comfortable viewing distance.
- 3Move the target slowly horizontally, vertically, and diagonally.
- 4Ask the patient to follow the target with the eyes only.
- 5Observe for saccadic pursuit, asymmetry, symptom provocation, or inability to maintain fixation.
Positive outcome
Saccadic, broken, asymmetric, or clearly impaired pursuit is abnormal. Abnormal smooth pursuit may occur with central nervous system disease, medication effects, fatigue, age, concussion, or visual impairment. It should not be used alone to diagnose central vertigo.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Leigh & Zee (2015) | oculomotor reference text, no diagnostic accuracy | NA | NA | NA | NA |
CommentSmooth pursuit is a screening observation in the oculomotor exam. It is sensitive to many non-vestibular factors and lacks stand-alone diagnostic accuracy for central vertigo. In the presence of new neurological symptoms or acute severe dizziness, abnormal pursuit should increase concern but not be the sole decision point.
Low Clinical Value