Abstract
We describe a patient with Wernicke's encephalopathy who showed spontaneous upbeat
nystagmus with decelerating slow phases that changed to downbeat nystagmus during
upward gaze and increased during downward gaze. He also showed horizontal gaze-evoked
nystagmus and impaired upward smooth pursuit. Magnetic resonance imaging demonstrated
symmetric lesions involving the bilateral medial thalami, periaqueductal gray matters
and inferior cerebellar peduncles. In this patient, the decelerating slow phases and
disobedience to Alexander's law of upbeat nystagmus suggest both deficient (leaky)
and unstable neural integrators subserving vertical eye motion. Dysfunction of the
interstitial nucleus of Cajal or its descending pathway to the vestibulocerebellum
via the paramedian tract cell groups may be responsible for the upbeat nystagmus and
its modulation by gazes in our patient with Wernicke's encephalopathy.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Ocular signs of Wernicke's disease.AMA Arch Ophthalmol. 1954; 51: 204-211
- Supranuclear and internuclear ocular motor disorders.in: Newman N.J. miller N.R. 5th ed. Walsh & Hoyt's clinical neuro-ophthalmology. vol. 1. Williams & Wilkins, Baltimore1998: 1189-1349
- Vestibular responses in Wernicke's encephalopathy.Ann Neurol. 1989; 26: 669-674
- Spontaneous vertical nystagmus.Rev Neurol Paris. 1989; 145: 527-532
- Primary position upbeating nystagmus a variety of central positional nystagmus.Brain. 1983; 106: 949-964
- The neurology of eye movements.3rd edn. Oxford University Press, New York1999
- Wernicke's encephalopathy presenting with upbeat nystagmus.J Clin Neurosci. 2002; : 9476-9478
- Upbeat nystagmus: clinicoanatomical correlations in 15 patients.J Clin Neurol. 2006; 2: 58-65
- Vertical vestibular responses to head impulses are symmetric in downbeat nystagmus.Neurology. 2004; 63: 621-625
- The mechanism of downbeat nystagmus.Arch Neurol. 1974; 30: 227-237
- The localizing value of nystagmus in brainstem disorders.Neuro-Ophthalmology. 1995; 15: 283-290
- Cerebellar control of ocular gaze stability.Ann Neurol. 1980; 7: 37-40
- Evidence for brainstem structures participating in oculomotor integration.Science. 2000; 288: 857-859
Article info
Publication history
Published online: September 14, 2010
Accepted:
August 6,
2010
Received in revised form:
August 2,
2010
Received:
February 5,
2010
Identification
Copyright
© 2010 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
