J Clin Neurol.  2020 Jan;16(1):163-165. 10.3988/jcn.2020.16.1.163.

Acute Vertical Pendular Nystagmus and Delayed Oculopalatal Tremor in a Patient with Bilateral Horizontal Gaze Palsy

• Lee H
• Kim HA

• KMID: 2467802
• DOI: http://doi.org/10.3988/jcn.2020.16.1.163

Abstract

No abstract available.

MeSH Terms

Humans
Nystagmus, Pathologic*
Paralysis*
Tremor*

Figure

• 

  Fig. 1 Acute and chronic vertical PN in bilateral pontine lesion. A: Three-dimensional VOG during the acute period showed small-amplitude (0.5–1°) oscillations in both eyes at a frequency of 3–4 Hz during visual fixation. The amplitude increased during vertical gaze (up to 3–4°) (i.e., gaze-evoked nystagmus); note the slow upward deviation of both eyes (arrow) with corrected downward eye movement. B: Axial brain diffusion-weighted MRI performed during the acute phase showed hyperintense lesions involving both medial medullae extending to the tegmentum, and both paramedian caudal pontine tegmenta. Brain T2-weighted MRI performed 18 months later showed a subtle high-intensity signal in the inferior olivary nucleus (arrow). C: Three-dimensional VOG performed 18 months after the acute event showed asymmetric vertical PN at a frequency of 3–4 Hz and a higher amplitude in the right eye (2.5–3°). The amplitude was decreased during visual fixation (2–2.5°). The torsional component was more prominent in the delayed PN than in the acute PN. Note the slow upward deviation of both eyes in the absence of fixation (arrow). LH: horizontal position of left eye, LT: torsional position of left eye, LV: vertical position of left eye, PN: pendular nystagmus, RH: horizontal position of left eye, RT: torsional position of right eye, RV: vertical position of right eye, VOG: video-oculography.

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