Background: We report an unusual case of Wernicke’s encephalopathy presenting with transient upbeat nystagmus that changed to a persistent downbeat nystagmus . Case: A 27-year-old man presented with upbeat nystagmus....Background: We report an unusual case of Wernicke’s encephalopathy presenting with transient upbeat nystagmus that changed to a persistent downbeat nystagmus . Case: A 27-year-old man presented with upbeat nystagmus. Three months earlie r, he had been diagnosed with Wernicke’s encephalopathy after fasting for a mon th. Observations: This diagnosis was supported by his symptoms (ataxia, a confus ed state). Clinical recovery followed thiamine therapy. His upbeat nystagmus had linear slow phases with average amplitude and frequency (±SD) during fixation straight ahead of 2.8±0.7°and 4.6±2.2Hz. respectively. Two months later, the primary position upbeat nystagmus had diminished and down beat nystagmus (0.9 + 0.5°and 3.2±0.7 Hz on average) for a 20°downward gaze had developed. Then, 8 months later, he showed only downbeat nystagmus, which obeyed Alexander’s law. His primary position downbeat nystagmus was completely suppressed by clonazepam, a γ-aminobutyric acid (GABA) agonist. Conclusions: Owing to an underlying cen tral vestibular imbalance, even after the recovery of acute neurological symptom s, Wernicke’s encephalopathy can be complicated by persistent downbeat nystagmu s, which can be treated by a GABA agonist.展开更多
We report the case of a 16 year old girl with verticaltorsional oscillations. She had a 4 year history of bilateral horizontal gaze palsy caused by a cavernous angioma in the medial part of the dorsal pons. She presen...We report the case of a 16 year old girl with verticaltorsional oscillations. She had a 4 year history of bilateral horizontal gaze palsy caused by a cavernous angioma in the medial part of the dorsal pons. She presented with vertical oscillopsia that had worsened during the past 3 months. Unilateral three dimensional eyemovements and bilateral horizontal eye movements were recorded using a magnetic search coil method and direct current electro-oculography, respectively. She had vertical-torsional oscillations (avera-ge frequency: 3.0 Hz) leaving vertical saccades and pursuits intact. The average amplitudes of the vertical and torsional components were 2.0° and 0.6° , respectively. Her horizontal rapid eye movements were severely impaired; however, her horizontal pursuits and slow phases of vestibulo-ocular reflex were only partially impaired (gain < 0.3, oculomotor range <± 9° ). Convergence and divergence were intact. Lesions, involving the medial part of the dorsal pons and bilateral paramedian pontine reticular formation can induce vertical and torsional oscillations without disruption of vertical rapid eye movements.展开更多
文摘Background: We report an unusual case of Wernicke’s encephalopathy presenting with transient upbeat nystagmus that changed to a persistent downbeat nystagmus . Case: A 27-year-old man presented with upbeat nystagmus. Three months earlie r, he had been diagnosed with Wernicke’s encephalopathy after fasting for a mon th. Observations: This diagnosis was supported by his symptoms (ataxia, a confus ed state). Clinical recovery followed thiamine therapy. His upbeat nystagmus had linear slow phases with average amplitude and frequency (±SD) during fixation straight ahead of 2.8±0.7°and 4.6±2.2Hz. respectively. Two months later, the primary position upbeat nystagmus had diminished and down beat nystagmus (0.9 + 0.5°and 3.2±0.7 Hz on average) for a 20°downward gaze had developed. Then, 8 months later, he showed only downbeat nystagmus, which obeyed Alexander’s law. His primary position downbeat nystagmus was completely suppressed by clonazepam, a γ-aminobutyric acid (GABA) agonist. Conclusions: Owing to an underlying cen tral vestibular imbalance, even after the recovery of acute neurological symptom s, Wernicke’s encephalopathy can be complicated by persistent downbeat nystagmu s, which can be treated by a GABA agonist.
文摘We report the case of a 16 year old girl with verticaltorsional oscillations. She had a 4 year history of bilateral horizontal gaze palsy caused by a cavernous angioma in the medial part of the dorsal pons. She presented with vertical oscillopsia that had worsened during the past 3 months. Unilateral three dimensional eyemovements and bilateral horizontal eye movements were recorded using a magnetic search coil method and direct current electro-oculography, respectively. She had vertical-torsional oscillations (avera-ge frequency: 3.0 Hz) leaving vertical saccades and pursuits intact. The average amplitudes of the vertical and torsional components were 2.0° and 0.6° , respectively. Her horizontal rapid eye movements were severely impaired; however, her horizontal pursuits and slow phases of vestibulo-ocular reflex were only partially impaired (gain < 0.3, oculomotor range <± 9° ). Convergence and divergence were intact. Lesions, involving the medial part of the dorsal pons and bilateral paramedian pontine reticular formation can induce vertical and torsional oscillations without disruption of vertical rapid eye movements.
