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Failure of Fixation Suppression of Spontaneous Nystagmus in Cerebellar Infarction: Frequency, Pattern, and a Possible Structure

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Abstract

To investigate the frequency and pattern of failure of the fixation suppression (FFS) of spontaneous nystagmus (SN) in unilateral cerebellar infarction, and to identify the structure responsible for FFS, 29 patients with acute, mainly unilateral, isolated cerebellar infarction who had SN with a predominantly horizontal component were enrolled in this study. The ocular fixation index (OFI) was defined as the mean slow phase velocity (SPV) of the horizontal component of SN with fixation divided by the mean SPV of the horizontal component of SN without fixation. The OFI from age- and sex-matched patients with vestibular neuritis was calculated and used as the control data. The FFS of SN was only found in less than half (41 %, 12/29) of the patients. Approximately 65 % (n = 7) of the patients with isolated anterior inferior cerebellar artery territory cerebellar infarction showed FFS, whereas only a quarter (n = 3) of the patients with isolated posterior inferior cerebellar artery (PICA) territory cerebellar infarction showed FFS. The proportion of gaze-evoked nystagmus (6/12 [50 %] vs. 2/17 [12 %], p = 0.04) and deficient gain of ipsilesional pursuit (10/12 [83 %] vs. 6/17 [35 %], p = 0.05) was more frequent in the FFS group than in the group without FFS. Lesion subtraction analysis in isolated PICA territory cerebellar infarction revealed that the nodulus was commonly damaged in patients with FFS, compared to that of patients without FFS. Our study shows that FFS of SN due to acute cerebellar infarction is less common than previously thought and the nodulus may be an important structure for the suppression of SN in humans.

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Acknowledgments

This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea Government (MSIP) (No. 2014R1A5A2010008).

Conflict of Interest

Dr. Lee serves on the editorial boards of Frontiers in Neuro-otology, Research in Vestibular Science and Current Medical Imaging Review, and received research support from DAWOONG PHARMACEUTICAL, Co. Ltd. Drs. Kim and Yi report no disclosures.

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Authors and Affiliations

  1. Department of Neurology, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, Republic of Korea

    Hyun-Ah Kim, Hyon-Ah Yi & Hyung Lee

  2. Brain Research Institute, School of Medicine, Keimyung University, Daegu, Republic of Korea

    Hyun-Ah Kim, Hyon-Ah Yi & Hyung Lee

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  1. Hyun-Ah Kim
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  2. Hyon-Ah Yi
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Correspondence to Hyung Lee.

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ESM 1

Overlapping MRI lesions in patients who had isolated AICA territory cerebellar infarction with (A) or without (B) FFS. The right-sided lesions were flipped to the left side. The number of overlapping lesions is illustrated by different colors that code for increasing frequencies, which range from violet (n = 1) to red (n = 11). An overlay plot of the subtracted superimposed lesions of patients with FFS minus the comparison (non-FFS) group. (C) The percentage of overlapping lesions of the group with nystagmus after subtraction of the comparison group is illustrated by five different colors, where dark red represents a difference of 1–20 % and white–yellow represents a difference of 81–100 %. Each color represents increments of 20 %. The regions are colored from dark blue (difference of 1–20 %) to light blue (difference of 81–100 %), indicating regions that were damaged more frequently in patients without FFSs. The Talairach z-coordinates of each transverse slice are given. This figure illustrates that damage to the anterior cerebellum possibly including the flocculus, was mostly responsible for the FFS in SN in these patients. Patients with FFS tended to have a lesion to the anterior cerebellum than the patients without FFS (5/7 [71.4 %] versus 1/4 [25 %], p = 0.24) (GIF 406 kb)

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Kim, HA., Yi, HA. & Lee, H. Failure of Fixation Suppression of Spontaneous Nystagmus in Cerebellar Infarction: Frequency, Pattern, and a Possible Structure. Cerebellum 15, 182–189 (2016). https://doi.org/10.1007/s12311-015-0688-2

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