(DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
Subject
Cerebellar; Jerk Nystagmus; Downbeat Nystagmus; Central Positional Nystagmus
Description
Although positional downbeat nystagmus (pDBN) can indicate the rare anterior canal variant of benign paroxysmal positional vertigo, central mimics are common causes of pDBN. pDBN may be seen in multiple system atrophy (MSA), or seen with posterior fossa lesions, with a common example being a stroke involving the nodulus/uvula (often accompanied by apogeotropic positional nystagmus with supine roll testing, not present in this patient). This patient had positional symptoms consistent with typical BPPV, but Dix-Hallpike and straight head-hanging caused persistent pure pDBN that did not abate with fixation (i.e., when video goggles were removed), did not change with empiric therapy for AC-BPPV (deep head hanging maneuvers were performed), and did not fatigue with repeated maneuvers - features which are highly suspicious of a central etiology. There was no spontaneous nystagmus when she was in an upright position. An MRI was done in the emergency room within several hours of onset and was negative. However, small posterior fossa strokes can be missed (perhaps ~10-20% of the time) in the first 24-48 hours. A repeat MRI was ordered given persistent symptoms/signs at a one-week follow-up, but she was unfortunately lost to follow-up.
Date
2017
Language
eng
Format
video/mp4
Type
Image/MovingImage
Collection
Neuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
Publisher
North American Neuro-Ophthalmology Society
Holding Institution
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890