Abstract
Upbeat nystagmus in the primary position of gaze with concomitant oscillopsia and postural instability is a pendant of downbeat nystagmus, and most probably reflects an imbalance of vertical vestibulo-ocular reflex tone. It has the same causes and involves central eye-head coordination in the pitch plane as mediated by pathways from the vertical semicircular canals and the otoliths. Since the manifestations are typically modulated by otolithic input arising from static head tilt (Fig. 8.1), upbeat nystagmus is also a kind of positional nystagmus (see central positional nystagmus, p. 165) in a broader sense. Two separate intra-axial brainstem lesions in the tegmentum of the pontomesencephalic and the pontomedullary junction near the perihypoglossal nuclei (Fig. B.l, Fig. 8.2) are likely to be responsible for this syndrome (Fisher et al. 1983), but there is insufficient evidence to show whether the cerebellar vermis is involved. Differential diagnosis includes gaze-evoked nystagmus, acquired pendular nystagmus, spasmus nutans, and rare forms of vertical congenital nystagmus. In coma it should not be confused with reversed ocular bobbing.
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References
Baker R, Berthoz A (1975) Is the prepositus hypoglossi nucleus the source of another vestibulo-ocular pathway? Brain Res 86:121–127
Baker R, Berthoz A (1976) Prepositus neurons synapse directly on vertical oculomotoneurons. Fed Proc 35:562
Bender MB, Gormen WF (1949) Vertical nystagmus on direct forward gaze with vertical oscillopsia.Am J Ophthalmol 32:967–972
Benjamin EE, Zimmermann CF, Troost BT (1986) Lateropulsion and upbeat nystagmus are manifestations of central vestibular dysfunction. Arch Neurol 43:962–964
Blair S, Gavin M (1979) Modification of the macaque’s vestibulo-ocular reflex after ablation of the cerebellar vermis. Acta Otolaryngol 88:225–243
Carl JR, Yee RD, Baloh RW (1982) Convergence and gaze effects on vertical nystagmus. Invest Ophthal Vision Res (Suppl) 22:265
Carpenter MB, Cowie RJ (1985) Connections and oculomotor projections of the superior vestibular nucleus and cell group “y”. Brain Res 336:265–287
Cox TA, Corbett JJ, Thompson HS, Lennarson L (1981) Upbeat nystagmus changing to downbeat nystagmus with convergence. Neurology 31:891–892
Daroff RB, Troost BT (1973) Upbeat nystagmus. JAMA 225:312
Fisher A, Gresty M, Chambers B, Rudge P (1983) Primary position upbeating nystagmus: a variety of central positional nystagmus. Brain 106:949–964
Forsythe WI (1955) Congenital hereditary vertical nystagmus. J Neurol Neurosurg Psychiat 18:196–198
Gilman N, Baloh RW, Tomiyasu U (1977) Primary position upbeat nystagmus. Neurology 27:294–298
Haddad GM, Demer JL, Robinson DA (1980) The effect of lesions of the dorsal cap of the inferior olive on the vestibulo-ocular ad optokinetic system of the cat. Brain Res 185:265–275
Hoyt CS, Gelbert SS (1984) Vertical nystagmus in infants with congenital ocular abnormalities. Ophthalm Paediat Genet (Amsterdam) 4:155–162
Ito M, Nisimaru N, Yamamoto M (1976) Pathways for the vestibulo-ocular reflex excitation arising from semicircular canals of rabbits. Exp Brain Res 24:257–271
Kato I, Nakamura T, Watanabe J, Harada K, Aoyagi M, Katagiri T (1985) Primary position upbeat nystagmus, localizing value. Arch Neurol 42:819–821
Keane JR, Itabashi HH (1987) Upbeat nystagmus: clinicopathologic study of two patients. Neurology 37:491–494
Murphy MG, O’Leary JL (1971) Neurological deficit in cats with lesions of the olivocerebellar system. Arch Neurol 24:145–157
Nakada T, Remler MP (1981) Primary position upbeat nystagmus. J Clin Neuroophthalmol 1:185–189
Neveling R, Kruse KE (1961) Über Nicotinnystagmus. Arch Ohr Heilk Z Hals Heilk 177:427–431
O’Brian FH, Bender MB (1945) Localizing value of vertical nystagmus. Arch Neurol Psychiat 54:378–380
Pawl R (1973) Upbeat nystagmus. JAMA 225:312
Precht W, Anderson WH, Blanks RHI (1979) Canal-otolith convergence on cat ocular motor-neurons. In: Granit R, Pompeiano O (eds) Reflex control of posture and movement. Elsevier, Amsterdam, pp 459–468 (Progress in Brain Research Vol 50)
Ranalli PJ, Sharpe JA (1988) Upbeat nystagmus and the ventral tegmental pathway of the upward vestibulo-ocular reflex. Neurology 38:1329–1330
Schmidt D (1972) Über die Bedeutung der Augensymptome zur Diagnostik der Wernicke-Encephalopathie. Klin Mbl Augenheilk 161:36–42
Shibasaki H, Yamashita Y, Motomura S (1978) Suppression of congenital nystagmus. J Neurol Neurosurg Psychiat 41:1078–1083
Sibony, PA, Evinger C, Manning KA (1987) Tobacco-induced primary position upbeat nystagmus. Ann Neurol 21:53–58
Sogg RL, Hoyt WF (1962) Intermittent vertical nystagmus in a father and son. Arch Ophthal (Chicago) 68:515–517
Spiegel EA, Scala NP (1941) Vertical nystagmus following lesions of the cerebellar vermis. Arch Ophthalmol 26:661–669
Stengel E (1935) Zur Frage der Herdlokalisation bei spontanem Vertikalnystagmus. Zeitschr Ges Neurol Psychiat 153:417–424
Troost BT, Martinez J, Abel LA, Heros RC (1980) Upbeat nystagmus and internuclear ophthalmoplegia with brainstem glioma. Arch Neurol 37:453–456
Zumstein HR, Meienberg O (1982) Upbeat nystagmus and visual system disorder in Wernicke’s encephalopathy due to starvation. Neuro-Ophthalmol 2:157–162
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Brandt, T. (1991). Upbeat Nystagmus/Vertigo Syndrome. In: Vertigo: Its Multisensory Syndromes. Clinical Medicine and the Nervous System. Springer, London. https://doi.org/10.1007/978-1-4471-3342-1_8
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DOI: https://doi.org/10.1007/978-1-4471-3342-1_8
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