Case Report

Neurological Sciences

, Volume 33, Issue 5, pp 1189-1191

Apogeotropic central positional nystagmus as a sole sign of nodular infarction

  • Hyun-Ah KimAffiliated withDepartment of Neurology, Keimyung University School of MedicineBrain Research Institute, Keimyung University School of Medicine
  • , Hyon-Ah YiAffiliated withDepartment of Neurology, Keimyung University School of MedicineBrain Research Institute, Keimyung University School of Medicine
  • , Hyung LeeAffiliated withDepartment of Neurology, Keimyung University School of MedicineBrain Research Institute, Keimyung University School of Medicine Email author 

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Abstract

Positional vertigo and nystagmus without associated neurological symptoms and signs are characteristic features of benign paroxysmal positional vertigo (BPPV). Although positional nystagmus may occur with caudal cerebellar infarction including the nodulus, positional nystagmus is usually associated with other neurological signs such as spontaneous or gaze-evoked nystagmus, perverted head-shaking nystagmus, cerebellar dysmetria, or severe gait ataxia with falling. We present a patient with nodular infarction who had positional vertigo with nystagmus as a sole manifestation. Video-oculography showed apogeotropic positional horizontal nystagmus during head turning while supine, which was consistent with apogeotropic BPPV involving the horizontal canal. MRI disclosed acute infarct in the nodulus. Nodulus infarction should be considered in a patient with positional nystagmus, especially when the presenting symptoms and signs are consistent with BPPV involving the horizontal canal.

Keywords

Central positional nystagmus Nodulus