Vertigo pp 199-213 | Cite as

Vestibular disorders in (sagittal) pitch plane

  • Thomas Brandt


A striking difference between vestibular tone imbalance in the roll and pitch planes is that roll dysfunction is caused by unilateral and pitch dysfunction by bilateral lesions of paired pathways in the brainstem or of the cerebellar flocculus (Brandt and Dieterich 1995). This structural difference probably explains why a vestibular tone imbalance in pitch frequently occurs with various intoxications or metabolic disorders. This is unusual for tone imbalance in yaw or roll, unless as a functional decompensation of an earlier (compensated) tone imbalance. Downbeat and upbeat nystagmus are not merely ocular motor disorders, but central vestibular disorders that also affect orientation and balance. A tone imbalance in the pitch plane manifests as vertical upbeating or downbeating nystagmus, fore-aft head-and-body tilt, and deviation of the subjective horizontal toward the direction of the slow phase of the nystagmus.


Cerebellar Degeneration Superior Rectus Downbeat Nystagmus Pitch Plane Postural Imbalance 
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© Springer-Verlag London 2003

Authors and Affiliations

  • Thomas Brandt
    • 1
  1. 1.Neurologische Klinik, Klinikum GroßhadernLudwig-Maximillians-UniversitätMunichGermany

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