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Adult Periodic Alternating Nystagmus Masked by Involuntary Head Movements

Kaski, D; Haider, S; Male, A; Radunovich, A; Liu, F; Cordivari, C; Bhatia, KP; (2018) Adult Periodic Alternating Nystagmus Masked by Involuntary Head Movements. Frontiers in Neurology , 9 , Article 326. 10.3389/fneur.2018.00326. Green open access

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Abstract

Acquired periodic alternating nystagmus (PAN) describes a horizontal jerk nystagmus that reverses its direction with a predictable cycle, and is thought to arise from lesions involving the brainstem and cerebellum. We report a 20-year-old patient with PAN who presented with an acute vertiginous episode and developed an involuntary head movement that initially masked the PAN. The involuntary head movements were abolished with a subtherapeutic dose of botulinum toxin to the neck muscles. We propose that the head movements initially developed as a compensatory movement to the nystagmus, to maintain visual fixation in the presence of the underlying nystagmus, and became an entrained involuntary behavior. This case highlights the importance of disambiguating psychogenic from organic pathology as this may have clinical therapeutic implications, in this case resolution of the most disabling symptom which was her head oscillations, leading to improved day-to-day function despite PAN.

Type: Article
Title: Adult Periodic Alternating Nystagmus Masked by Involuntary Head Movements
Open access status: An open access version is available from UCL Discovery
DOI: 10.3389/fneur.2018.00326
Publisher version: https://www.frontiersin.org/articles/10.3389/fneur...
Language: English
Additional information: © 2018 Kaski, Haider, Male, Radunovich, Liu, Cordivari, Bhatia and Bronstein. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/).
Keywords: periodic alternating nystagmus, head tremor, oscillopsia, vestibulo-ocular reflex, rhombencephalitis, psychogenic
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Movement Neurosciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > ION Central Administration
URI: http://discovery.ucl.ac.uk/id/eprint/10049621
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