Nystagmus changes direction in acute peripheral vestibular lesion?!?

When you see nystagmus to changes direction, you know that’s a central vestibular lesion. However, can peripheral vestibular lesions have a clinical presentation with alternating nystagmus? It seems to be. This is a more recent work, which describes alternating nystagmus in several patients with peripheral vestibular lesion (Mb Meniere, neuritis, vestibular schwannoma); however in all described cases alternating nystagmus was present for short period, nystagmus was suppressed by fixation (which is not characteristic of central Ny) and all tests for central vestibular pathways were fine.

Periodic alternating nystagmus of peripheral vestibular origin

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