Impaired Tilt Suppression of Post-Rotatory Nystagmus and Cross-Coupled Head-Shaking Nystagmus in Cerebellar Lesions: Image Mapping Study
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We sought to determine the cerebellar structures responsible for tilt suppression of post-rotatory nystagmus. We investigated ocular motor findings and MRI lesions in 73 patients with isolated cerebellar lesions who underwent recording of the vestibulo-ocular reflex (VOR) using rotatory chair tests. Tilt suppression of post-rotatory nystagmus was diminished in 27 patients (27/73, 37.0 %). The gains of the VOR and the TCs of per- and post-rotatory nystagmus did not differ between the patients with diminished and with normal tilt suppression. The patients with impaired tilt suppression showed perverted (“cross-coupled”) head-shaking nystagmus (pHSN) and central positional nystagmus (CPN) more frequently than those with normal responses. Tilt suppression was impaired in five (71.4 %) of the seven patients with isolated nodulus and uvular infarction. Probabilistic lesion-mapping analysis showed that the nodulus and uvula are responsible for tilt suppression. Impaired tilt suppression may be ascribed to disruption of cerebellar contribution to the vestibular velocity-storage mechanism, which integrates information from the semicircular canals and otolith organs to help derive the brain’s estimate of the head orientation relative to the pull of gravity.
KeywordsVertigo Nystagmus Vestibulo-ocular reflex Nodulus Uvula
This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI10C2020).
Dr. Lee wrote the manuscript and analyzed and interpreted the data.
Drs. Choi, Park, Koo, H.J. Kim, and Zee analyzed and interpreted the data and revised the manuscript.
Dr. J.S. Kim conducted the design, and conceptualized the study, interpreted the data, and revised the manuscript.
Compliance with Ethical Standards
All experiments followed the tenets of the Declaration of Helsinki and this study was approved by the Institutional Review Board of Seoul National University Bundang Hospital (B-1505-298-107).
Conflict of Interest
The authors declare that they have no conflict of interest.
Drs. Lee, Choi, Park, and Koo and H.J. Kim report no disclosure.
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 and received research support from SK Chemicals, Co. Ltd.
Dr. Zee receives research support from the National Institutes of Health and is an Associate Editor of Frontiers in Neuro-otology and a member of the Editorial Board of The Cerebellum. He received speaker’s honoraria from Abbott, Micromed, Sun pharmaceuticals, and the American Academy of Neurology.
- 1.Baloh RW, Kerber K. Baloh and Honrubia’s clinical neurophysiology of the vestibular system. New York: Oxford University Press; 2010.Google Scholar
- 3.Dai M, Klein A, Cohen B, Raphan T. Model-based study of the human cupular time constant. J Vestib Res. 1998;9(4):293–301.Google Scholar
- 4.Leigh RJ, Zee DS. The neurology of eye movements. 4th ed. New York: Oxford University Press; 2006.Google Scholar