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Central Positional Nystagmus from Focal Brain Lesion
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Ja Won Koo, Kwang Dong Choi, So Young Moon, Seong Ho Park, Ji Soo Kim
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J Korean Bal Soc. 2004;3(1):129-135.
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 Abstract
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- Department of Otolaryngology, Head and Neck Surgery1, and Neurology2, Seoul National University Bundang Hospital,
Seoul National University College of Medicine, Seongnam, Korea
Background and Objectives : Central positional nystagmus is induced by positional changes from brainstem or
cerebellar lesions. Differentiation central from peripheral positional nystagmus is important in clinical practice. To
delineate characteristics of the positional nystagmus observed in central lesions, we analyzed the parameters of
positional nystagmus from focal brain lesions.
Materials and Methods : Ten patients with central positional nystagmus were recruited from the dizziness clinic
of Seoul National University Bundang Hospital. All the patients had focal brainstem or cerebellar lesions documented
by magnetic resonance imaging. The nystagmus was observed with and without fixation by using Frenzel glasses or
Video Goggles. The nystagmus was videotaped or recorded with video-oculography. Provoking positional maneuvers,
direction, latency, duration, phase reversal, and fatigue phenomenon of the nystagmus were analyzed.
Results
: Of the 10 patients, seven had infarctions in the lateral medulla or inferior cerebellum while two
experienced cerebellar hemorrhage and remaining one showed a compression of the ventrolateral medulla by cavernous
malformation of the vertebral artery. The directions of the positional nystagmus were variable depending on the lesions
and provoking maneuvers. Most patients exhibited direction-changing nystagmus without latency, direction-reversal and
fatigue phenomenon. However, some of the patients also showed patterns of nystagmus characteristic of peripheral
positional nystagmus. In two of the four patients with infarction in the territory of medial posterior inferior cerebellar
artery, the positional nystagmus was the only abnormal findings.
Conclusions
: Central positional nystagmus may share many characteristics with peripheral type of positional
nystagmus. In individual cases, the patterns of nystagmus should be interpreted with caution in differentiating central
from peripheral positional nystagmus. Considering the isolated positional nystagmus in some patients with caudal
cerebellar lesions, systematic positional maneuvers should be applied to all the patients with vertigo
Key Words : Positional nystagmus, Medulla, Cerebellum
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Ocular Contrapulsion in Medial Medullary Infarction
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Ji Soo Kim, So Young Moon, Seon Mi Jeong, Moon Ku Han, Seong Ho Park
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J Korean Bal Soc. 2003;2(2):227-230.
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Abstract
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- Ocular contrapulsion refers to a syndrome of static ocular deviation and saccadic hypermetria toward the intact side, and saccadic hypometria and impaired smooth pursuit toward the lesion side. It has been reported in patients with lesions in the rostral cerebellum and caudal medullary hemorrhge. We report a 60-year-old man who showed ocular contrapulsion with unilateral upper medial medullary infarction. Ocular contrapulsion may be a sign of medial medullary infarction. In our patient, the climbing fibers may be damaged before crossing the midline in the upper medulla.
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