Medial medullary syndromes

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Identifier Medial Medullary syndromes
Title Medial medullary syndromes
Subject Medulla; Jerk Nystagmus; Upbeat Nystagmus; Gaze Evoked Nystagmus; Vestibular Nystagmus; Acute Vestibular
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine
Description This is a video of two patients who suffered small strokes involving the right medial medulla, and who presented with acute vertigo and oscillopsia. The first patient in the video had pure upbeat nystagmus, while the second patient had upbeat-torsional (towards the right ear) nystagmus in addition to gaze-evoked, direction-changing nystagmus (also a central sign in patients with the acute vestibular syndrome). Spontaneous vertical nystagmus is almost always central in origin. While medications like 4-aminopyridine or baclofen may occasionally be helpful to alleviate upbeat nystagmus (UBN), fortunately the upbeat will almost always eventually by itself over weeks or months. UBN from pontomedullary pathology is usually the result of: • Damage to the nucleus intercalatus/nucleus of Roller: • Results in increased activation of flocculus, decreased anterior canal [AC] tone and relative increase in posterior canal [PC] pathway tone -> downward drift and upward (upbeat) fast phase • Damage to the cell groups of the paramedian tracts - Involved in vertical gaze holding • Damage to the ventral tegmental tract (VTT) - Carries AC fibers or upward pathways so that damage to the VTT causes decreased anterior canal [AC] tone and relative increase in posterior canal [PC] pathway tone -> downward drift and upward (upbeat) fast phase. The second patient's gaze-evoked nystagmus is almost certainly the result of damage to the nucleus prepositus hypoglossi (NPH)- medial vestibular nucleus (MVN) complex, as these structures are responsible for horizontal gaze holding.
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2016
Type Image/MovingImage
Format video/mp4
Rights Management Copyright 2016. For further information regarding the rights to this collection, please visit:
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Language eng
ARK ark:/87278/s68m0jq7
Setname ehsl_novel_gold
Date Created 2016-10-27
Date Modified 2017-12-04
ID 187754
Reference URL
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