A 36-year-old man with a history of hypertension and atrial fibrillation presented with acute vertigo and imbalance. Neurologic examination revealed ataxic gait and ageotropic positional nystagmus during head-turning while supine (video on the Neurology® Web site at www.neurology.org). Other findings of the neurologic examination were normal. MRI showed bilateral nodular infarction (figure).
Figure Diffusion-weighted axial (A) and sagittal (B) and T2-weighted coronal (C) MRI disclose isolated nodular infarction (arrow). The inset indicates the imaging plane of the corresponding image
Central positional nystagmus mostly develops in lesions involving the brainstem or cerebellum.1 Isolated nodular infarction may show spontaneous horizontal, periodic alternating, post-head-shaking, and positional nystagmus in addition to imbalance.2 Ageotropic central positional nystagmus may be a manifestation of nodular infarction and should be differentiated from benign positional vertigo involving the horizontal semicircular canal.2
Footnotes
-
Supplemental data at www.neurology.org
Supported by a grant of the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (A080750).
Disclosure: Dr. Nam, Dr. S. Kim, and Dr. Huh report no disclosures. Dr. J.S. Kim serves as an Associate Editor of the Journal of Korean Neurological Association and on the editorial board of the Journal of Korean Society for Clinical Neurophysiology
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Hastening the Diagnosis of Amyotrophic Lateral Sclerosis
Dr. Brian Callaghan and Dr. Kellen Quigg