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
Subject Torsional Nystagmus; Jerk Nystagmus; Headshaking; Downbeat Nystagmus; Cerebellar Pathology
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, The Johns Hopkins School of Medicine
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.
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.
Contributor Daniel R. Gold, D.O. Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine; The Johns Hopkins University School of Medicine
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2019-06
Format video/mp4
Rights Management Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s6m08nrv
Setname ehsl_novel_gold
Date Created 2019-06-10
Date Modified 2019-09-12
ID 1427579
Reference URL https://collections.lib.utah.edu/ark:/87278/s6m08nrv
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