Central Persistent Direction-Changing Apogeotropic Positional Nystagmus скачать в хорошем качестве

Central Persistent Direction-Changing Apogeotropic Positional Nystagmus

A 65-year-old female presented in the mid-October 2023 with 2-weeks history of spontaneous vertigo but worse on lying down and aggravated on getting from supine. Oculomotor examination revealed a horizontal left beating spontaneous nystagmus with removal of fixation (by video-oculography infrared goggles). The horizontal head impulse test elicited a catch-up saccade on heaving the head to right. The tandem Romberg’s test and tandem walking were mildly impaired but there no upper and lower limb dysmetria. The otoneurologic examination revealed normal vertical and horizontal saccadic and smooth pursuit eye movements. The positional test results are as under – I. Bow and Lean Test: elicits left beating nystagmus on lean position and in the bow position it disappears. II. Supine Roll Test: elicits apogeotropic horizontal positional nystagmus on lateral head roll to the right and left. On the left lateral head roll direction reversal was conspicuously very late to occur. Atypical clinical findings (spontaneous left beating horizontal nystagmus, positive head impulse test, mild gait ataxia, disappearance of spontaneous left beating nystagmus on bow test and a very late direction reversal of horizontal positional nystagmus on left lateral head roll) instigated us to order a contrast magnetic resonance imaging of brain with dedicated cuts of the posterior fossa. MRI Brain with contrast showed an enhancing lesion in the lateral wall of the 4th ventricle. Differentials are hemangioblastoma, Tuberculoma, and Metastasis