Upbeat nystagmus due to a giant vertebral artery aneurysm

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Conflict of interest

None of the authors has any conflict of interest to disclose.

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Correspondence to Ji-Soo Kim.

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Video 1. Patient shows upbeat nystagmus with decreasing slow phase velocities. Without fixation, the slow phases of the nystagmus become more linear, and disjunctive torsional components, clockwise (from the patient’s perspective) in the right eye and counterclockwise in the left eye, are associated with the upbeat nystagmus.

Video 2. The upbeat nystagmus decreases in lateral and upward gazes, and increases in downward gaze. Leftward gaze also induces left beating nystagmus. The nystagmus changes into downbeat during convergence.

Video 3. The upbeat nystagmus decreases in the supine position and reversed to downbeat with counterclockwise torsional component in the prone position.

Video 4. Since the anterior semicircular canal (AC) innervate ipsilateral superior rectus (SR) and contralateral inferior oblique (IO), disruption of the pathways from both ACs generates downward ocular deviation and upbeat nystagmus. However, as SR is mainly an elevator and IO is primarily an extorter, the prevailing extorting action of IO would generate disjunctive extorsional nystagmus in association with upbeat nystagmus. III = oculomotor nucleus, IV = trochlear nucleus, VI = abducens nucleus.

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Hyun, J.W., Choi, S.Y., Huh, Y.E. et al. Upbeat nystagmus due to a giant vertebral artery aneurysm. Neurol Sci 34, 805–807 (2013) doi:10.1007/s10072-012-1143-5

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  • Vertigo
  • Upbeat nystagmus
  • Downbeat nystagmus
  • Aneurysm
  • Medulla