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J Korean Bal Soc > Volume 6(2); 2007 > Article
Journal of the Korean Balance Society 2007;6(2): 161-166.
소뇌 소절 병변에서 회전후안진의 고개숙임 억제
, , , , 오선영, 최광동, 김정은, 구자원, 김지수
서울의대 신경과학교실1, 전북의대 신경과학교실2, 부산의대 신경과학교실3, 건양의대 신경과학교실4, 서울의대 이비인후과학교실5
Tilt Suppression of the Post-rotatory Nystagmus in Cerebellar Nodular Lesions
Sun Young Oh, Kwang Dong Choi, Jung Eun Kim, Ja Won Koo, Ji Soo Kim
1Department of Neurology, Seoul National University College of Medicine, Korea. jisookim@snu.ac.kr
2Department of Neurology, Chonbuk National University College of Medicine, Korea.
3Department of Neurology, Pusan National University School of Medicine and Medical Research Institute, Korea.
4Department of Neurology, Konyang University College of Medicine, Korea.
5Department of Otolaryngology, Seoul National University College of Medicine, Korea.
Background and Objectives:   Head tilt at the end of step rotation about a vertical axis decreases the time constant (TC) of the post-rotatory nystagmus, which is known as tilt-suppression of the vestibulo-ocular reflex (VOR). Tilt suppression of the VOR is mediated by the cerebellar nodulus and ventral uvula and is eliminated after surgical ablation of those structures. However, studies on the tilt suppression of the VOR have been sparse in humans with cerebellar lesions.
Materials and Methods:  
Five patients with circumscribed cerebellar lesions involving the nodulusor ventral uvula underwent recording of spontaneous and positional nystagmus, and the VOR. To evaluate tilt suppression of the VOR, the participants pitched their head forward at the end of step rotation about a vertical axis both in the clockwise and counter-clockwise directions.
The VOR gain was increased in a patient with infarction in the territory of the medial posterior inferior cerebellar artery while the gain of visually enhanced VOR was normal in all the patients. The time constants of perand post-rotatory nystagmus was increased in a patient with increased VOR gain and the tilt suppression of the post-rotatory nystagmus was impaired in two patients, either uni- or bilaterally. Spontaneous downbeat and central positional nystagmus were frequently accompanied.
Nodular lesion may impair tilt suppression of the VOR. Measurement of tilt suppressive effect of the VOR may provide a valuable tool for evaluating the nodular dysfunction.
Keywords: Head-shaking nystagmus; Cerebellum; Nodulus
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