Eyes wide shut: Horizontal Direction Changing Nystagmus in a Left Cerebellar-Medullary Stroke. Favourable outcome after thrombolysis.
J Stroke Cerebrovasc Dis
; : 107986, 2024 Aug 31.
Article
en En
| MEDLINE
| ID: mdl-39222702
ABSTRACT
OBJECTIVE:
To describe a patient with a posterior inferior cerebellar artery stroke exhibiting a horizontal direction changing nystagmus with a complex clinical phenotype. MATERIALS ANDMETHODS:
A 78-year-old man presented with acute vertigo and gait imbalance. He was dysphagic and ataxic on the left side. He had a fast, small-amplitude right-beating nystagmus in the primary gaze position and in the gaze towards the right. Towards the left, a coarse left-beating nystagmus was seen.RESULTS:
Radiographic leftwards ocular deviation was evident on admission CT. Intravenous fibrinolysis was administered. 48-hour Holter-EKG, transthoracic ecochardiogram, and transcranial doppler were unremarkable. Brain MRI demonstrated an acute stroke involving the left medulla and cerebellum, mainly within the territory of the ipsilateral posterior inferior cerebellar artery. DISCUSSION ANDCONCLUSIONS:
Horizontal direction changing nystagmus can arise secondary to central lesions as brainstem strokes, it can be spontaneous or gaze-evoked and characteristically remains unchanged after fixation removal. In our case, the vestibular spontaneous and contralesional nystagmus was likely related to lower-brainstem damage; on the other hand, the ipsilesional gaze-evoked nystagmus might be related to lesions of the nucleus prepositus hypoglossi and/or cerebellum, both playing an important role in gaze-holding. Our findings suggest that central lesions with concurrent involvement of the ipsilateral vestibulo-ocular and horizontal gaze-holding pathways can cause direction changing nystagmus with complex phenotypes.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Idioma:
En
Revista:
J Stroke Cerebrovasc Dis
Asunto de la revista:
ANGIOLOGIA
/
CEREBRO
Año:
2024
Tipo del documento:
Article
Pais de publicación:
Estados Unidos