Spontaneous central vestibular nystagmus is a jerk nystagmus due to dysfunction of the central nervous system circuits that contribute to the vestibulo-ocular reflexes or adaptive control of these reflexes, and is caused by diseases of the brainstem and its connection with the vestibulocerebellum (ie, flocculus, paraflocculus, and nodulus).

Spontaneous central vestibular nystagmus may have any trajectory. In some cases, the central nature of the nystagmus is apparent because the trajectory cannot be readily explained by common forms of peripheral vestibular dysfunction affecting one or more semicircular canals or their afferents (eg, purely downbeat, upbeat, or torsional forms of nystagmus are all of central origin). In other cases, the central nature of the disorder is only obvious because of additional nystagmus attributes, accompanying central oculormotor or neurologic signs, or the overall clinical context.

In acute vertigo syndromes, central vestibular nystagmus often has a predominantly horizontal trajectory (pure or mixed horizontal-torsional), so it may be easily mistaken for spontaneous peripheral vestibular nystagmus, as seen typically with vestibular neuritis or other conditions. Most commonly this form of nystagmus is due to cerebellar or brainstem stroke.
This may be separated from vestibular neuritis by specific features: Section on separation of peripheral from central vestibular disorders.