Research in Vestibular Science

Case Reports

Neuromyelitis Optica Spectrum Disorder Presented with Upbeat Nystagmus and Intractable Vomiting: Hyunsoo Kim, Jae-Myung Kim, Tai-Seung Nam, Seung-Han Lee; Res Vestib Sci. 2019;18(2):50-53. Published online June 15, 2019; DOI: https://doi.org/10.21790/rvs.2019.18.2.50

Abstract PDF: Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating autoimmune disease of central nervous system characterized by relapsing attacks that target the optic nerves and spinal cord, as well as aquaporin-4 (AQP4) enriched periventricular brain regions. The area postrema (AP), located in the dorsal medulla, is the chemosensitive vomiting center and has high AQP-4 expression. The AP syndrome with unexplained hiccups, nausea, and vomiting is one of the core clinical characteristics in the NMOSD and maybe the first presenting symptom. We experienced a 25-year-old woman presented with intractable vomiting, dizziness and oscillopsia. Upbeat nystagmus detected on the bedside examination led to comprehensive neurological workups including magnetic resonance imaging, and she was diagnosed as the AP syndrome. Ten months later, she experienced a recurrence as a longitudinally extensive transverse myelitis and the diagnosis was finally compatible with NMOSD without AQP4-IgG. NMOSD, especially the AP syndrome, should be considered in any dizzy patient with intractable vomiting, and detailed neuro-otologic and neuro-ophthalmologic examinations are warranted for the correct diagnosis.

One Case of Downbeat Nystagmus with Compression of Vestibulocochlear Nerve by Vertebral Arteries: Gyu Cheol Han, Ju Hyoung Lee, Jong Su Ha, Hee Young Hwang, Cheol Wan Park; J Korean Bal Soc. 2004;3(1):184-186.

Abstract PDF: A case is reported of downbeat nystagmus associated with compression of the root of vestibulocochlear nerve by vertebral arteries, which was revealed by magnetic resonance imaging. Chief complain of the patient was positional vertigo, which aggrevated at left decubitus position. Downbeat nystagmus was increased in left Dix-hall pike test. Tetsuo et al, reported downbeat nystagmus with compression of dolichoectatic vertebral arteries to the medulla oblongata and surgical neurovascular decompression of the dolichoectasia reverses the progression of symptoms if permanent neurologic damage has not already occurred. Key Words : Vertical nystagmus, Vertebrobasilar dolichoectasia, Vestibulocochlear nerve

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