Leftward head rotations in a patient with a rotational vertebral artery occ
lusion syndrome elicited recurrent uniform attacks of severe rotatory verti
go and tinnitus in the right ear. These attacks were accompanied by a mixed
clockwise torsional downbeat nystagmus with a horizontal component toward
the right. A transient ischemia of the right labyrinth probably induced the
attacks and led to a combined transient excitation of the right anterior a
nd horizontal semicircular canals as well as the cochlea.