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Video Report
Aperiodic alternating nystagmus in acute lateral medullary infarction: a video report
Ji-Yun Parkorcid
Research in Vestibular Science 2024;23(2):61-62.
DOI: https://doi.org/10.21790/rvs.2024.010
Published online: June 14, 2024

Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea

Corresponding author: Ji-Yun Park Department of Neurology, Ulsan University Hospital, Ulsan University Medical School, 25 Daehakbyeongwon-ro, Dong-gu, Ulsan 44033, Korea E-mail: bingbing@uuh.ulsan.kr
• Received: June 3, 2024   • Revised: June 11, 2024   • Accepted: June 12, 2024

© 2024 The Korean Balance Society

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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An 81-year-old man presented with acute vertigo, left tilt, and headache for 1 day. Neurologic examination revealed spontaneous waxing and waning nystagmus with horizontal directional changes with omnidirectional gaze-evoked nystagmus and vigorous left-beating nystagmus on the head-shaking test. Diffusion-weighted magnetic resonance imaging demonstrated an acute infarction involving the left lateral medulla (Fig. 1A). Videooculography showed aperiodic alternating nystagmus (aPAN) with an irregular interval (Supplementary Video 1, Fig. 1B). Spontaneous right-beating nystagmus (peak slow-phase velocity, 10.4°/sec) lasted 104 seconds and gradually decreased. The nystagmus then changed direction to the left and lasted for 134 seconds (peak slow-phase velocity, 7.9°/sec) before reversing to the right again.
aPAN, which exhibits spontaneous alternating nystagmus without periodicity and regularity, is rarely seen in association with various peripheral and central vestibular disorders [1-3]. In lateral medullary stroke, aPAN may be caused by impairment of velocity storage and gaze holding [2].

Funding/Support

None.

Conflicts of Interest

Ji-Yun Park is the Editor-in-Chief of Research in Vestibular Science and was not involved in the review process of this article. All authors have no other conflicts of interest to declare.

Availability of Data and Materials

All data generated or analyzed during this study are included in this published article. For other data, these may be requested through the corresponding author.

Supplementary materials can be found via https://doi.org/10.21790/rvs.2024.010.

Supplementary Video 1.

Videooculography showed aperiodic alternating nystagmus with an irregular interval. Initially, spontaneous right-beating nystagmus (peak slow-phase velocity, 10.4°/sec) lasted 104 seconds and gradually decreased. The nystagmus then switched direction to the left and lasted for 134 seconds (peak slow-phase velocity, 7.9°/sec) before reversing back to the right again.
Fig. 1.
Brain magnetic resonance imaging demonstrated high signal intensity (arrow) in the left lateral medulla on the diffusion-weighted image (A). The plotting of the nystagmus reveals a spontaneous right-beating nystagmus (peak slow-phase velocity, 10.4°/sec) that reverses to left-beating nystagmus (peak slow-phase velocity, 7.9°/sec) and then reversing back to the right. A negative value indicates a rightward direction of the slow components of nystagmus (B).
rvs-2024-010f1.jpg
  • 1. Kim SH, Chung WK, Kim BG, Hwang CS, Kim MJ, Lee WS. Periodic alternating nystagmus of peripheral vestibular origin. Laryngoscope 2014;124:980–983.ArticlePubMed
  • 2. Kim SH, Kim JS. Aperiodic alternating nystagmus in lateral medullary strokes. Can J Neurol Sci 2019;46:486–488.ArticlePubMed
  • 3. Nuti D, Ciacci G, Giannini F, Rossi A, Federico A. Aperiodic alternating nystagmus: report of two cases and treatment by baclofen. Ital J Neurol Sci 1986;7:453–459.ArticlePubMedPDF

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        Aperiodic alternating nystagmus in acute lateral medullary infarction: a video report
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