Idiopathic downbeat nystagmus exacerbated with positional maneuvers
Downbeat nystagmus, Jerk nystagmus, Central positional nystagmus
Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine
This is a 45-yo-woman with vertical oscillopsia for 6+ months, found to have downbeat nystagmus on examination. She mainly complained of dizziness and oscillopsia when laying down. She was found to have a significant exacerbation in her baseline downbeat nystagmus with straight head hanging, and in right and left Dix-Hallpike. Although positional downbeat nystagmus (pDBN) can be seen with the uncommon anterior canal variant of BPPV, usually it is seen with disorders of the cerebellum or cervicomedullary junction. When pDBN is seen in a patient with parkinsonism, multiple system atrophy should be a consideration. In this patient, the downbeat was in isolation, there was no cerebellar ataxia, and extensive evaluation was unrevealing. Number of Figures and legend for each: 0 Number of Videos and legend for each: 1, Patient with downbeat nystagmus, most prominent with positional maneuvers.
Spencer S. Eccles Health Sciences Library, University of Utah