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Aperiodic alternating nystagmus in isolated vestibular nucleus infarction

  • Chang-Hee Kim
  • Kwang-Dong ChoiEmail author
Letter to the Editors
  • 27 Downloads

Dear Sirs,

In patients with an acute vestibular syndrome, it is sometimes challenging to make a differential diagnosis between acute peripheral vestibulopathy (APV) and central vestibular disorders [1]. Isolated acute vertigo has been reported in a tiny infarct involving caudal cerebellum [2, 3, 4, 5] or vestibular nucleus (VN) [6, 7]. Patients with isolated VN infarction mostly presented with combined clinical features of peripheral and central vestibulopathy [6, 7]. However, aperiodic alternating nystagmus has not been described in isolated VN infarction. We report a patient with isolated VN infarction who initially presented with clinical manifestations of APV, and subsequently developed aperiodic alternating nystagmus.

A 57-year-old previously healthy woman developed acute spontaneous vertigo with nausea and vomiting. On examination, she showed right-beating spontaneous nystagmus (SN) with a torsional component, which was attenuated by visual fixation (Supplemental video 1). A...

Notes

Compliance with ethical standards

Conflicts of interest

We have no disclosure of any competing interest.

Ethical approval for research involving human participants and/or animals

All experiments followed the tenets of the Declaration of Helsinki, and this study was approved by the institutional review board.

Supplementary material

415_2019_9504_MOESM1_ESM.avi (327.5 mb)
Supplemental Video 1. The patient show right-beating spontaneous nystagmus about 15 hours after symptom onset (AVI 335404 kb)
415_2019_9504_MOESM2_ESM.avi (175.2 mb)
Supplemental Video 2. The patient show aperiodic alternating nystagmus about 40 hours after symptom onset (upper panel of Fig. 1b). (AVI 179396 kb)

References

  1. 1.
    Strupp M, Mandala M, Lopez-Escamez JA (2019) Peripheral vestibular disorders: an update. Curr Opin Neurol 32:165–173CrossRefGoogle Scholar
  2. 2.
    Jeong HS, Oh JY, Kim JS, Kim J, Lee AY, Oh SY (2007) Periodic alternating nystagmus in isolated nodular infarction. Neurology 68:956–957CrossRefGoogle Scholar
  3. 3.
    Moon IS, Kim JS, Choi KD, Kim MJ, Oh SY, Lee H, Lee HS, Park SH (2009) Isolated nodular infarction. Stroke 40:487–491CrossRefGoogle Scholar
  4. 4.
    Oh YM, Choi KD, Oh SY, Kim JS (2006) Periodic alternating nystagmus with circumscribed nodular lesion. Neurology 67:399CrossRefGoogle Scholar
  5. 5.
    Lee H, Yi HA, Cho YW, Sohn CH, Whitman GT, Ying S, Baloh RW (2003) Nodulus infarction mimicking acute peripheral vestibulopathy. Neurology 60:1700–1702CrossRefGoogle Scholar
  6. 6.
    Kim HA, Lee H (2010) Isolated vestibular nucleus infarction mimicking acute peripheral vestibulopathy. Stroke 41:1558–1560CrossRefGoogle Scholar
  7. 7.
    Kim HJ, Lee SH, Park JH, Choi JY, Kim JS (2014) Isolated vestibular nuclear infarction: report of two cases and review of the literature. J Neurol 261:121–129CrossRefGoogle Scholar
  8. 8.
    Ahn SH, Shin JE, Kim CH (2017) Final diagnosis of patients with clinically suspected vestibular neuritis showing normal caloric response. J Clin Neurosci 41:107–110CrossRefGoogle Scholar
  9. 9.
    Kim CH, Na BR, Park HJ, Shin JE (2013) Impairment of static vestibular function is limited in patients with sudden sensorineural hearing loss with vertigo. Audiol Neurootol 18:208–213CrossRefGoogle Scholar
  10. 10.
    Murofushi T, Chihara Y, Ushio M, Iwasaki S (2008) Periodic alternating nystagmus in Meniere's disease: the peripheral type? Acta Otolaryngol 128:824–827CrossRefGoogle Scholar
  11. 11.
    Kim CH, Yang YS, Im D, Shin JE (2016) Nystagmus in patients with unilateral acute otitis media complicated by serous labyrinthitis. Acta Otolaryngol 136:559–563CrossRefGoogle Scholar
  12. 12.
    Kim SH, Chung WK, Kim BG, Hwang CS, Kim MJ, Lee WS (2014) Periodic alternating nystagmus of peripheral vestibular origin. Laryngoscope 124:980–983CrossRefGoogle Scholar
  13. 13.
    Kim SH, Kim JS (2019) Aperiodic alternating nystagmus in lateral medullary strokes. Can J Neurol Sci Le J Can des Sci Neurol 46:486–488CrossRefGoogle Scholar
  14. 14.
    Park BR, Kim MS, Kim JH, Jin YZ (2001) Effects of acute hypotension on neuronal activity in the medial vestibular nuclei of rats. NeuroReport 12:3821–3824CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical ScienceKonkuk University School of MedicineSeoulRepublic of Korea
  2. 2.Department of Neurology, Pusan National University HospitalPusan National University School of Medicine and Biomedical Research InstituteBusanSouth Korea

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