Slit Lamp Demonstration of Heartbeat Nystagmus Due to Superior Canal Dehiscence

A 61-year-old woman developed oscillopsia triggered by the Valsalva maneuver secondary to barotrauma. The neuro-ophthalmologic examination was normal, except for the slit lamp examination, which showed fine torsional eye movement (). After Valsalva maneuver, the patient developed a conjugate torsional/upbeat nystagmus with the upper poles beating toward the right shoulder. It was synchronous with the heartbeat (). Temporal bone CT demonstrated right superior canal dehiscence (Figure).

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