Upbeat nystagmus during head rotation in rotational vertebral artery occlusion
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Rotational vertebral artery occlusion (RVAO) is characterized by recurrent attacks of paroxysmal vertigo, nystagmus, tinnitus, and syncope induced by horizontal head rotation [1, 2, 3, 4, 5, 6]. Most patients with RVAO exhibit a stenosis or anomaly of the vertebral artery (VA) on one side and compression of the dominant VA at the C1-2 level during contraversive head rotation, which compromises the blood flow in the vertebrobasilar artery territory. The induced nystagmus in RVAO was mostly mixed downbeat and horizontal, with or without a torsional component [3, 4, 5]. Based on the patterns of induced nystagmus and accompanying tinnitus, transient ischemia and the resulting excitation of the peripheral labyrinth in the side of the compressed VA has been proposed as a mechanism of the vertigo and nystagmus during head rotation in RVAO [3, 4, 5, 6]. We report upbeat nystagmus induced by head rotation in a patient with RVAO, which has not been previously described.
KeywordsVertebral Artery Head Rotation Spontaneous Nystagmus Vestibular Nystagmus Recurrent Vertigo
This work was supported by a Grant of the Korean Heath Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A070001).
Conflicts of interest
We have no disclosure of any competing interest.
The authors declare that they acted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.