Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Primary Position Upbeat Nystagmus: Localizing Value

Primary Position Upbeat Nystagmus: Localizing Value Abstract Primary position upbeat nystagmus has been associated clinically with lesions of the midbrain,1 cerebellar vermis,2-5 brachium conjunctivum,6 and lower brain stem near the inferior olive.7-9 However, only the latter two lesions have been confirmed pathologically.6-8 Even in these studies, the precise localization remains unclear. We report a case of primary position upbeat nystagmus with a discrete vascular lesion that involved the hypoglossal nucleus and and adjacent structures. REPORT OF A CASE A 39-year-old woman was admitted seven days after a sudden onset of dysarthria and vertical oscillopsia. Results of an examination showed primary position upbeat nystagmus that persisted in all directions of gaze. No other oculomotor abnormalities were noticed. The tongue deviated to the right; fasciculation and slight atrophy were seen on the right side of the tongue with simultaneous palatal weakness (Fig 1). No other abnormal signs were observed.Normal laboratory studies included complete References 1. Troost BT, Martinez J, Abel LA, et al Upbeat nystagmus and internuclear ophthalmoplegia with brainstem glioma . Arch Neurol 198737:453-456.Crossref 2. Bender MB, Gormen WF: Vertical nystar mus on direct forward gaze with vertical oscillor sia . Am J Ophthalmol 1949;32:967-972. 3. Pawl R: Upbeat nystagmus . JAMA 1973225:312.Crossref 4. Daroff R, Hoyt W: Supranuclear disorders of ocular control systems in man , in Bach-y-Rich P. Collins CC (eds): The Control of Eye Movements . New York, Academic Press Inc. 1971. p 175-235. 5. Daroff R. Troost T: Upbeat nystagmas JAMA 1973;225:312.Crossref 6. Nakada T, Remler MP: Primary position upbeat nystagmus . J Clin Neuro Ophthalmol 1981;1:185-189.Crossref 7. Gilman N, Baloh RW, Tomiyasu U: Primary position upbeat nystagmus . Neurology 1977;27:294-298.Crossref 8. O'Brien FH, Bender MB: Localizing value of vertical nystagmus . Arch Neurol Psychiatry 1945;54:378-380.Crossref 9. Schatz N, Schlezinger N, Berry R: Vertical upbeat nystagmus on downward gaze: A clinical pathological correlation, abstracted . Neurology 1975;25:380. 10. Kato I, Sato Y, Aoyagi M, et al: Caloric pattern test with special reference to failure of fixation-suppression . Acta Otolaryngol 1979;88:97-104.Crossref 11. Kato I, Nakamura T, Koike Y, et al: Computer analysis of fixation-suppression of caloric nystagmus . ORL 1982;44:277-287.Crossref 12. Kato I, Nakamura T, Kimuara Y, et al: Visual-vestibular interaction in central nervous system disorders , Ann NY Acad Sci 1981;374:764-773.Crossref 13. Zee D. Friendlich A. Robinson D: The mechanism of downbeat nystagmus . Arch Neurol 1974;30:227-237.Crossref 14. Mehdorn E, Kommerell G, Meienberg O: Primary position vertical nystagmus: 'Directional preponderance' of the pursuit system? Graefes Arch Clin Exp Opthalmol 1979;209:209-217.Crossref 15. Baloh RW, Spooner JW: Downbeat nystagmus: A type of central vestibular nystagmus . Neurologh 1981;31:304-310.Crossref 16. VanGilder JC, Allen WE, Lesser RA: Pontine abscess: Survival following surgical drainage . J Neurosurg 1974;40:386-390.Crossref 17. Maekawa K, Simpson JI: Climbing fiber responses evoked in the vestibulocerebellum of rabbt from visual system . J Neurophysiol 1973; 36:649-666. 18. Mizuno N, Nakamura Y, Iwahori N: An electron microscope study of the dorsal cap of the inferior olive in the rabbit, with special reference to the pretecto-olivary fibers . Brain Res 1974; 77:385-395.Crossref 19. Kato I, Kawasaki M, Aoyagi M, et al: Loss of visual suppression of caloric nystagmus in cats . Acta Otolaryngol 1979;87:499-505.Crossref 20. Haddad GM, Demer JL, Robinson DA: The effect of lesions of the dorsal cap of the inferior olive on the vestibulo-ocular and optokinetic system of the cat . Brain Res 1980;185:265-275.Crossref 21. Miles FA, Fuller JH, Braitman DJ, et al: Long-term adaptive changes in primate vestibulo-ocular reflex: III. Electrophysiological observations in flocculus of normal monkeys . J Neurophysiol 1980;43:1437-1476. 22. Murphy MG, O'Leary JL: Neurological deficit in cats with lesions of the olivocerebellar system . Arch Neurol 1971;24:145-157.Crossref 23. Kato I, Kawasaki T, Sato Y, et al: Visual suppression of caloric nystagmus and optokinetic responses in cats . Ada Otolaryngol 1980;89:497-503.Crossref 24. Spiegel EA, Scala NP: Vertical nystagmus following lesions of the cerebellar vermis . Arch Ophthalmol 1941;26:661-669.Crossref 25. Ron S, Robinson DA: Eye movements evoked by cerebellar stimulation in the alert monkey . J Neurophysiol 1973;36:1004-1022. 26. Carmel PW, Antunes JL, Hilel SK, et al: Dandy-Walker syndrome: Clinico-pathologic features and re-evaluation of modes of treatment . Surg Neurol 1977;8:132-138. 27. Lipton HL, Prezosi TJ, Moses H: Adult onset of the Dandy-Walker syndrome . Arch Neurol 1978;35:672-674.Crossref 28. Mercuri S, Curatolo P, Giuffre R, et al: Agenesis of the vermis cerebelli and malformations of the posterior fossa in childhood and adolescence . Neurochirurgia 1979;22:180-188. 29. Tal Y, Freigang B, Dunn HG, et al: Dandy-Walker syndrome: Analysis of 21 cases . Dev Med Child Neurol 1980;22:189-201.Crossref 30. Huong TT, Goldbatt E, Simpson DA: Dandy-Walker syndrome associated with congenital heart defects: Report of three cases . Dev Med Child Neurol 1975;17:35-41.Crossref 31. Blair S, Gavin M: Modification of the macaque's vestibulo-ocular reflex after ablation of the cerebellar vermis . Acta Otolaryngol 1979; 88:235-243.Crossref 32. Evinger L, Fuchs A, Baker R: Bilateral lesions of the medial longitudinal fasciculus in monkeys: Effects of the horizontal and vertical components of voluntary and vestibular induced eye movements . Exp Brain Res 1977;28:1-20. 33. Cogan DG, Wray SH: Internuclear ophthalmoplegia as an early sign of brainstem tumors . Neurology 1970;20:629-634.Crossref 34. Kirkham TH, Katsarkas A: An electrooculographic study of internuclear ophthalmoplegia . Ann Neurol 1977;2:385-392.Crossref 35. Spiller WG: Ophthalmoplegia internuclearis anterior: A case with necropsy . Brain 1924; 47:345-357.Crossref 36. Ross AT, DeMyer WE: Isolated syndrome of the medial longitudinal fasciculus in man: Anatomical confirmation . Arch Neurol 1966; 15:203-205.Crossref 37. Gordon RM, Bender MB: Visual phenomena in lesions of the median longitudinal fasciculus . Arch Neurol 1966;15:238-240.Crossref 38. Baker R: The nucleus prepositus hypoglossi , in Brooks BA, Bajandas FJ (eds): Eye Movements . New York, Plenum Publishing Co, 1976, pp 145-178. 39. Baker R, Berthoz A: Is the prepositus hypoglossi nucleus the source of another vestibulo-ocular pathway? Brain Res 1975;86:121-127.Crossref 40. Baker It, Berthoz A: Prepositus neurons synapse directly on vertical oculomotoneurons . Fed Proc 1976;35:562. 41. Kato I, Harada K: Role of the prepositus hypoglossi on primary position upbeat nystagmus. Ada Otolaryngol, in press. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Loading next page...
 
/lp/american-medical-association/primary-position-upbeat-nystagmus-localizing-value-HQZpvvqDu5
Publisher
American Medical Association
Copyright
Copyright © 1985 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1985.04210090087024
Publisher site
See Article on Publisher Site

Abstract

Abstract Primary position upbeat nystagmus has been associated clinically with lesions of the midbrain,1 cerebellar vermis,2-5 brachium conjunctivum,6 and lower brain stem near the inferior olive.7-9 However, only the latter two lesions have been confirmed pathologically.6-8 Even in these studies, the precise localization remains unclear. We report a case of primary position upbeat nystagmus with a discrete vascular lesion that involved the hypoglossal nucleus and and adjacent structures. REPORT OF A CASE A 39-year-old woman was admitted seven days after a sudden onset of dysarthria and vertical oscillopsia. Results of an examination showed primary position upbeat nystagmus that persisted in all directions of gaze. No other oculomotor abnormalities were noticed. The tongue deviated to the right; fasciculation and slight atrophy were seen on the right side of the tongue with simultaneous palatal weakness (Fig 1). No other abnormal signs were observed.Normal laboratory studies included complete References 1. Troost BT, Martinez J, Abel LA, et al Upbeat nystagmus and internuclear ophthalmoplegia with brainstem glioma . Arch Neurol 198737:453-456.Crossref 2. Bender MB, Gormen WF: Vertical nystar mus on direct forward gaze with vertical oscillor sia . Am J Ophthalmol 1949;32:967-972. 3. Pawl R: Upbeat nystagmus . JAMA 1973225:312.Crossref 4. Daroff R, Hoyt W: Supranuclear disorders of ocular control systems in man , in Bach-y-Rich P. Collins CC (eds): The Control of Eye Movements . New York, Academic Press Inc. 1971. p 175-235. 5. Daroff R. Troost T: Upbeat nystagmas JAMA 1973;225:312.Crossref 6. Nakada T, Remler MP: Primary position upbeat nystagmus . J Clin Neuro Ophthalmol 1981;1:185-189.Crossref 7. Gilman N, Baloh RW, Tomiyasu U: Primary position upbeat nystagmus . Neurology 1977;27:294-298.Crossref 8. O'Brien FH, Bender MB: Localizing value of vertical nystagmus . Arch Neurol Psychiatry 1945;54:378-380.Crossref 9. Schatz N, Schlezinger N, Berry R: Vertical upbeat nystagmus on downward gaze: A clinical pathological correlation, abstracted . Neurology 1975;25:380. 10. Kato I, Sato Y, Aoyagi M, et al: Caloric pattern test with special reference to failure of fixation-suppression . Acta Otolaryngol 1979;88:97-104.Crossref 11. Kato I, Nakamura T, Koike Y, et al: Computer analysis of fixation-suppression of caloric nystagmus . ORL 1982;44:277-287.Crossref 12. Kato I, Nakamura T, Kimuara Y, et al: Visual-vestibular interaction in central nervous system disorders , Ann NY Acad Sci 1981;374:764-773.Crossref 13. Zee D. Friendlich A. Robinson D: The mechanism of downbeat nystagmus . Arch Neurol 1974;30:227-237.Crossref 14. Mehdorn E, Kommerell G, Meienberg O: Primary position vertical nystagmus: 'Directional preponderance' of the pursuit system? Graefes Arch Clin Exp Opthalmol 1979;209:209-217.Crossref 15. Baloh RW, Spooner JW: Downbeat nystagmus: A type of central vestibular nystagmus . Neurologh 1981;31:304-310.Crossref 16. VanGilder JC, Allen WE, Lesser RA: Pontine abscess: Survival following surgical drainage . J Neurosurg 1974;40:386-390.Crossref 17. Maekawa K, Simpson JI: Climbing fiber responses evoked in the vestibulocerebellum of rabbt from visual system . J Neurophysiol 1973; 36:649-666. 18. Mizuno N, Nakamura Y, Iwahori N: An electron microscope study of the dorsal cap of the inferior olive in the rabbit, with special reference to the pretecto-olivary fibers . Brain Res 1974; 77:385-395.Crossref 19. Kato I, Kawasaki M, Aoyagi M, et al: Loss of visual suppression of caloric nystagmus in cats . Acta Otolaryngol 1979;87:499-505.Crossref 20. Haddad GM, Demer JL, Robinson DA: The effect of lesions of the dorsal cap of the inferior olive on the vestibulo-ocular and optokinetic system of the cat . Brain Res 1980;185:265-275.Crossref 21. Miles FA, Fuller JH, Braitman DJ, et al: Long-term adaptive changes in primate vestibulo-ocular reflex: III. Electrophysiological observations in flocculus of normal monkeys . J Neurophysiol 1980;43:1437-1476. 22. Murphy MG, O'Leary JL: Neurological deficit in cats with lesions of the olivocerebellar system . Arch Neurol 1971;24:145-157.Crossref 23. Kato I, Kawasaki T, Sato Y, et al: Visual suppression of caloric nystagmus and optokinetic responses in cats . Ada Otolaryngol 1980;89:497-503.Crossref 24. Spiegel EA, Scala NP: Vertical nystagmus following lesions of the cerebellar vermis . Arch Ophthalmol 1941;26:661-669.Crossref 25. Ron S, Robinson DA: Eye movements evoked by cerebellar stimulation in the alert monkey . J Neurophysiol 1973;36:1004-1022. 26. Carmel PW, Antunes JL, Hilel SK, et al: Dandy-Walker syndrome: Clinico-pathologic features and re-evaluation of modes of treatment . Surg Neurol 1977;8:132-138. 27. Lipton HL, Prezosi TJ, Moses H: Adult onset of the Dandy-Walker syndrome . Arch Neurol 1978;35:672-674.Crossref 28. Mercuri S, Curatolo P, Giuffre R, et al: Agenesis of the vermis cerebelli and malformations of the posterior fossa in childhood and adolescence . Neurochirurgia 1979;22:180-188. 29. Tal Y, Freigang B, Dunn HG, et al: Dandy-Walker syndrome: Analysis of 21 cases . Dev Med Child Neurol 1980;22:189-201.Crossref 30. Huong TT, Goldbatt E, Simpson DA: Dandy-Walker syndrome associated with congenital heart defects: Report of three cases . Dev Med Child Neurol 1975;17:35-41.Crossref 31. Blair S, Gavin M: Modification of the macaque's vestibulo-ocular reflex after ablation of the cerebellar vermis . Acta Otolaryngol 1979; 88:235-243.Crossref 32. Evinger L, Fuchs A, Baker R: Bilateral lesions of the medial longitudinal fasciculus in monkeys: Effects of the horizontal and vertical components of voluntary and vestibular induced eye movements . Exp Brain Res 1977;28:1-20. 33. Cogan DG, Wray SH: Internuclear ophthalmoplegia as an early sign of brainstem tumors . Neurology 1970;20:629-634.Crossref 34. Kirkham TH, Katsarkas A: An electrooculographic study of internuclear ophthalmoplegia . Ann Neurol 1977;2:385-392.Crossref 35. Spiller WG: Ophthalmoplegia internuclearis anterior: A case with necropsy . Brain 1924; 47:345-357.Crossref 36. Ross AT, DeMyer WE: Isolated syndrome of the medial longitudinal fasciculus in man: Anatomical confirmation . Arch Neurol 1966; 15:203-205.Crossref 37. Gordon RM, Bender MB: Visual phenomena in lesions of the median longitudinal fasciculus . Arch Neurol 1966;15:238-240.Crossref 38. Baker R: The nucleus prepositus hypoglossi , in Brooks BA, Bajandas FJ (eds): Eye Movements . New York, Plenum Publishing Co, 1976, pp 145-178. 39. Baker R, Berthoz A: Is the prepositus hypoglossi nucleus the source of another vestibulo-ocular pathway? Brain Res 1975;86:121-127.Crossref 40. Baker It, Berthoz A: Prepositus neurons synapse directly on vertical oculomotoneurons . Fed Proc 1976;35:562. 41. Kato I, Harada K: Role of the prepositus hypoglossi on primary position upbeat nystagmus. Ada Otolaryngol, in press.

Journal

Archives of NeurologyAmerican Medical Association

Published: Aug 1, 1985

References