Journal of Neurology

, Volume 264, Issue 9, pp 2024–2026 | Cite as

Ictal downbeat nystagmus in bilateral Meniere’s disease

  • Sun-Uk Lee
  • Hyo-Jung Kim
  • Eek-Sung Lee
  • Jeong-Yoon Choi
  • Ji-Soo KimEmail author
Letter to the Editors

Dear Sirs,

Pure or predominantly vertical nystagmus mostly indicates a lesion involving the central vestibular structures, and downbeat nystagmus is usually observed in inferior cerebellar lesions [1]. Herein, we describe ictal downbeat nystagmus in a patient with bilateral MD.

A 70-year-old man with hypertension and diabetes mellitus presented recurrent spontaneous vertigo and fluctuating tinnitus for 4 years. The vertigo usually lasted 30 min, but occasionally up to 2 h. The vertigo was usually accompanied by machine-roaring sounds in both ears. The tinnitus had started in the right ear 4 years before, but became bilateral 2 years later. The tinnitus became louder during the vertigo attacks. In 2016, we were able to perform video-oculography during an attack (about 30 min after the onset of vertigo), which initially documented spontaneous nystagmus beating downward, leftward, and counter-clockwise (from the patient’s perspective) and then reversed its horizontal and torsional...


Author contributions

Dr. SUL analyzed and interpreted the data, and wrote the manuscript. Drs. HJK, ESL and JYC analyzed and interpreted the data, and revised the manuscript. Dr. JSK designed and conceptualized the study, interpreted the data, and revised the manuscript.

Compliance with ethical standards

Financial disclosures

This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (no. NRF-2016R1D1A1B04935568).

Conflicts of interest

Drs. S. U. Lee, I. S. Lee, H. J. Kim and Choi report no disclosures. Dr. J. S. Kim serves as an associate editor of Frontiers in Neuro-otology and on the editorial boards of the Journal of Korean Society of Clinical Neurophysiology, Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, Journal of Vestibular Research, Journal of Neurology, and Medicine.

Ethical standard

This study followed the tenets of the Declaration of Helsinki, and was performed according to the guidelines of Institutional Review Board of Seoul National University Bundang Hospital (B-1109/135-106).

Supplementary material

Video. During an attack of Meniere’s disease, the patient shows spontaneous nystagmus beating downward, leftward, and counter-clockwise (from the patient’s perspective) without fixation. Then the spontaneous nystagmus reverses its horizontal and torsional directions into rightward and clockwise while the downbeat component remained unchanged. (WMV 18075 kb)


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of NeurologySeoul National University College of Medicine, Seoul National University Bundang HospitalSeongnamSouth Korea
  2. 2.Research Administration TeamSeoul National University Bundang HospitalSeongnamSouth Korea
  3. 3.Department of NeurologySoonchunhyang University Bucheon HospitalBucheonSouth Korea

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