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Reversed Corrective Saccades during Head Impulse Test in Acute Cerebellar Dysfunction

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Abstract

Patients with cerebellar lesions may show horizontal (positive)- or downward (perverted)-corrective saccades during horizontal head impulse test (HIT). However, corrective saccades in the direction of head rotation (reversed corrective saccades) have not been reported during HIT. We present two patients who showed reversed corrective saccades during horizontal HIT as an initial sign of acute cerebellitis. In contrast to the corrective saccades mostly observed in peripheral vestibular paresis, this paradoxical response indicates abnormally increased vestibulo-ocular responses due to cerebellar disinhibition over the vestibulo-ocular reflex. This paradoxical response should be considered an additional bedside cerebellar sign.

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Conflict of Interest

No conflicting relationship exists for the authors.

Disclosure

Dr. J-S Kim serves as an Associate Editor of Frontiers in Neuro-otology and on the editorial boards of the Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, and Journal of Vestibular Research, and received research support from SK Chemicals, Co. Ltd. The other authors have nothing to disclose.

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Authors and Affiliations

  1. Department of Neurology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, South Korea

    Jeong-Yoon Choi, Jin-Man Jung, Do-Young Kwon & Moon Ho Park

  2. Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea

    Ji-Soo Kim

  3. Department of Nuclear Medicine, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, South Korea

    Chulhan Kim

  4. Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, South Korea

    June Choi

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  1. Jeong-Yoon Choi
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  2. Ji-Soo Kim
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  3. Jin-Man Jung
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  4. Do-Young Kwon
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  5. Moon Ho Park
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  6. Chulhan Kim
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  7. June Choi
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Correspondence to Ji-Soo Kim.

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Both patients show increased gain of the vestibulo-ocular reflex (VOR) and reversed corrective saccades during horizontal head impulse test (HIT) (paradoxical head impulse sign). In patient 2, perverted corrective saccade was also noted during head impulse to the right (WMV 36,251 kb)

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Choi, JY., Kim, JS., Jung, JM. et al. Reversed Corrective Saccades during Head Impulse Test in Acute Cerebellar Dysfunction. Cerebellum 13, 243–247 (2014). https://doi.org/10.1007/s12311-013-0535-2

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  • DOI: https://doi.org/10.1007/s12311-013-0535-2

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