Neurological Sciences

, Volume 33, Issue 5, pp 1189–1191 | Cite as

Apogeotropic central positional nystagmus as a sole sign of nodular infarction

  • Hyun-Ah Kim
  • Hyon-Ah Yi
  • Hyung LeeEmail author
Case Report


Positional vertigo and nystagmus without associated neurological symptoms and signs are characteristic features of benign paroxysmal positional vertigo (BPPV). Although positional nystagmus may occur with caudal cerebellar infarction including the nodulus, positional nystagmus is usually associated with other neurological signs such as spontaneous or gaze-evoked nystagmus, perverted head-shaking nystagmus, cerebellar dysmetria, or severe gait ataxia with falling. We present a patient with nodular infarction who had positional vertigo with nystagmus as a sole manifestation. Video-oculography showed apogeotropic positional horizontal nystagmus during head turning while supine, which was consistent with apogeotropic BPPV involving the horizontal canal. MRI disclosed acute infarct in the nodulus. Nodulus infarction should be considered in a patient with positional nystagmus, especially when the presenting symptoms and signs are consistent with BPPV involving the horizontal canal.


Central positional nystagmus Nodulus 


  1. 1.
    Arai M, Terakawa I (2005) Central paroxysmal positional vertigo. Neurology 64:1284PubMedCrossRefGoogle Scholar
  2. 2.
    Anagnostou E, Mandellos D, Limbitaki G, Papadimitriou A, Anastasopoulos D (2006) Positional nystagmus and vertigo due to a solitary brachium conjunctivum plaque. J Neurol Neurosurg Psychiatry 77:790–792PubMedCrossRefGoogle Scholar
  3. 3.
    Büttner U, Helmchen C, Brandt T (1999) Diagnostic criteria for central versus peripheral positioning nystagmus and vertigo: a review. Acta Otolaryngol 119:1–5PubMedCrossRefGoogle Scholar
  4. 4.
    Lee H, Sohn SI, Cho YW et al (2006) Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology 67:1178–1183PubMedCrossRefGoogle Scholar
  5. 5.
    Lee SH, Kim JS (2010) Benign paroxysmal positional vertigo. J Clin Neurol 6:51–63PubMedCrossRefGoogle Scholar
  6. 6.
    Bertholon P, Tringali S, Faye MB, Antoine C, Martin C (2006) Prospective study of positional nystagmus in 100 consecutive patients. Ann Otol Rhinol Laryngol 115:587–594PubMedGoogle Scholar
  7. 7.
    Johkura K (2007) Central paroxysmal positional vertigo: isolated dizziness caused by small cerebellar hemorrhage. Stroke 38:e26–e27PubMedCrossRefGoogle Scholar
  8. 8.
    Lee H, Yi HA, Cho YW et al (2003) Nodulus infarction mimicking acute peripheral vestibulopathy. Neurology 60:1700–1702PubMedCrossRefGoogle Scholar
  9. 9.
    Kim HA, Lee H, Yi HA, Lee SR, Lee SY, Baloh RW (2009) Pattern of otolith dysfunction in posterior inferior cerebellar artery territory cerebellar infarction. J Neurol Sci 280:65–70PubMedCrossRefGoogle Scholar
  10. 10.
    Moon IS, Kim JS, Choi KD et al (2009) Isolated nodular infarction. Stroke 40:487–491PubMedCrossRefGoogle Scholar
  11. 11.
    Sheliga BM, Yakushin SB, Silvers A, Raphan T, Cohen B (1999) Control of spatial orientation of the angular vestibulo-ocular reflex by the nodulus and uvula of the vestibulocerebellum. Ann N Y Acad Sci 871:94–122PubMedCrossRefGoogle Scholar
  12. 12.
    Aschan G, Ekvall L, Grant G (1963) Nystagmus following stimulation in the central vestibular pathways using permanently implanted electrodes. Acta Otolaryngol Suppl 192:63+Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of NeurologyKeimyung University School of MedicineDaeguSouth Korea
  2. 2.Brain Research InstituteKeimyung University School of MedicineDaeguSouth Korea

Personalised recommendations