Journal of Neurology

, Volume 261, Issue 6, pp 1213–1215 | Cite as

Upbeat nystagmus during head rotation in rotational vertebral artery occlusion

  • Seung-Ha Park
  • Seong-Jang Kim
  • Jae-Deuk Seo
  • Dae-Hyun Kim
  • Jae-Hwan Choi
  • Kwang-Dong ChoiEmail author
  • Ji Soo Kim
Letter to the Editors

Dear Sirs,

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.

A 35-year-old...


Vertebral Artery Head Rotation Spontaneous Nystagmus Vestibular Nystagmus Recurrent Vertigo 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.

Ethical standards

The authors declare that they acted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

Supplementary material

415_2014_7328_MOESM1_ESM.wmv (9.3 mb)
Supplementary material 1 Leftward head rotation induces convergent eye motion with horizontal and vertical saccadic oscillation of small amplitude and high frequency, which is followed by prominent upbeat nystagmus with a small left-beating component. The upbeat nystagmus decreases over the following 20 seconds even though the rotated head posture is maintained. (WMV 9557 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Seung-Ha Park
    • 1
  • Seong-Jang Kim
    • 2
  • Jae-Deuk Seo
    • 3
  • Dae-Hyun Kim
    • 4
  • Jae-Hwan Choi
    • 5
  • Kwang-Dong Choi
    • 1
    Email author
  • Ji Soo Kim
    • 6
    • 7
  1. 1.Department of Neurology, College of MedicinePusan National University Hospital, Pusan National University School of Medicine and Medical Research InstituteBusanKorea
  2. 2.Department of Nuclear Medicine, Pusan National University HospitalPusan National University School of Medicine and Medical Research InstituteBusanKorea
  3. 3.Department of NeurologyBone HospitalBusanKorea
  4. 4.Department of NeurologyDong-A University College of MedicineBusanKorea
  5. 5.Department of Neurology, Pusan National University Yangsan HospitalPusan National University School of Medicine and Biomedical Research InstituteBusanKorea
  6. 6.Department of NeurologySeoul National University College of MedicineSeoulKorea
  7. 7.Seoul National University Bundang HospitalSeongnamKorea

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