Downbeat (Perverted) Head Shaking Nystagmus in a Patient with Spontaneous Torsional Nystagmus

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Identifier Downbeat_perverted_head_shaking_nystagmus_in_a_patient_with_spontaneous_torsional_nystagmus
Title Downbeat (Perverted) Head Shaking Nystagmus in a Patient with Spontaneous Torsional Nystagmus
Alternative Title Video 6.9 Cross-coupled head-shaking-induced nystagmus-a "central" sign from Neuro-Ophthalmology and Neuro-Otology Textbook
Creator Daniel R. Gold, DO
Affiliation (DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
Subject Torsional Nystagmus; Jerk Nystagmus; Headshaking; Downbeat Nystagmus; Cerebellar Pathology
Description 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 75-year-old woman with vascular risk factors who experienced abrupt onset imbalance and dizziness. Symptoms were maximal at onset, and she denied progression over 6 months. Clinically, it was felt that she had suffered a stroke, although an MRI one months later demonstrated an unremarkable posterior fossa. At the time of this exam (6 months after onset), she had spontaneous torsional nystagmus with the top poles of the eyes beating toward the right ear in all directions of gaze. Following horizontal head-shaking (HS), there was downbeat nystagmus (so-called "perverted" nystagmus given vertical nystagmus after horizontal HS), which is a well described central pattern1. Perverted HSN is typically seen with lesions of the flocculus or nodulus, although other localizations have been described. This is likely be related to disinhibition of the (upward or anti-gravity) anterior canal (AC) pathways. Horizontal HS can therefore cause an upward bias due to uninhibited AC pathways (while horizontal canals are mainly stimulating with horizontal HS, so too are the vertical canals), with a resultant downward fast phase causing downbeat nystagmus. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: This patient had spontaneous torsional nystagmus with the top poles of the eyes beating toward the right ear in all directions of gaze, and following horizontal head-shaking (HS), there was downbeat nystagmus (so-called "crosscouping" nystagmus given vertical nystagmus after horizontal HS), which is a well-described central pattern. This cross-coupled response is usually due to a vestibulocerebellar lesion (likely flocculus or nodulus), and in cases with flocculus impairment, it may be related to disinhibition of the (upward or anti-gravity) anterior canal (AC) pathways. Horizontal HS can therefore cause an upward bias due to uninhibited AC pathways (while horizontal canals are mainly stimulating with horizontal HS, so too are the vertical canals), with a resultant downward fast phase causing downbeat nystagmus https://collections.lib.utah.edu/ark:/87278/s6m08nrv
Date 2019-06
References 1. Choi JY, Jung I, Jung JM, et al. Characteristics and mechanism of perverted head-shaking nystagmus in central lesions: Video-oculography analysis. Clin Neurophysiol 2016;127:2973-2978.
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
Rights Management Copyright 2016. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s6m08nrv
Setname ehsl_novel_gold
ID 1427579
Reference URL https://collections.lib.utah.edu/ark:/87278/s6m08nrv
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