alcohol and gazed evoked nystagmus

[GEM]

Vestibular function testing is to be performed when a patient is "alcohol free" for 48 hours. However, I performed eye movement tests on a patient who had consumed 1 pint of cider the night previous to testing as they had not read the information leaflet prior to their appt and i thought i would compare results to the next appt (where it has been pointed out again not to consume alcohol).

Results:
third degree left beating nystagmus without fixation was produced on gaze testing and left beating nystagmus on head shake.
however, head thrust was only positive on the right.

the history was an allergic reaction to a bite on the left ear, with HL at the time and continuous tinnitus in that ear. rotatory vertigo is experienced every day for 15 mins (especially on turning the head and in crowded places).

she is not suitable for calorics as she has a heart condition. I am wondering if it is required to bring her back just due to 1 pint of cider. But her results seem to contradict what the expected would be.

[Guy]

Hi GEM,
Any update you can give us on this interesting one?
Perhaps we should be using cider on all patients!

Note that "a heart condition" does not necessarily contraindicate the caloric test - in many instances doing the caloric is fine so long as the cardiac condition is not recent, is stable and appropriately medicated. The referring medic should have already assessed the patient in this regard but even if the green light is given, use your common sense - a grey and clammy patient rings my alarm bells.