Hostname: page-component-848d4c4894-tn8tq Total loading time: 0 Render date: 2024-07-05T12:22:23.317Z Has data issue: false hasContentIssue false
  • English
  • Français

Posterior semicircular canal paroxysmal positional vertigo triggers a new type of windmill nystagmus

Published online by Cambridge University Press:  17 December 2019

F Comacchio ,
N Cutrì  and
M Mion
F Comacchio
Affiliation:
Regional Specialized Vertigo Center, Institute of Otolaryngology, Department of Neurosciences, University of Padua, Italy
N Cutrì
Affiliation:
Otolaryngology Ambulatorial Service, Socio Sanitary District, Padua, Italy
M Mion*
Affiliation:
Institute of Otolaryngology, Department of Neurosciences, University of Padua, Italy
*
Author for correspondence: Dr Marta Mion, Institute of Otolaryngology, Department of Neurosciences, University of Padua, Via Nicolò Giustiniani 2, 35121Padua, Italy E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Periodic alternating nystagmus is a rare condition characterised by spontaneous horizontal nystagmus that periodically reverses direction, indicating an alteration of the velocity storage mechanism. Windmill nystagmus is a peculiar and rare variant of periodic alternating horizontal nystagmus with a superimposed periodic alternating vertical nystagmus. It is generally observed in blind patients.

Case report

This paper presents the unique case of a normally sighted patient with a windmill nystagmus triggered by an episode of benign paroxysmal positional vertigo due to bilateral posterior canalolithiasis. Videonystagmography revealed an anticlockwise up-beating nystagmus followed by a clockwise down-beating nystagmus with a cycle lasting 2 minutes, followed by a brief burst of horizontal left-beating nystagmus.

Conclusion

This case report represents the first observation of a new type of windmill nystagmus, probably provoked by a malfunction of the velocity storage mechanism, gaze-stabilisation and short-adaptation networks, with a loss of cerebellar inhibition.

Keywords

Benign Paroxysmal Positional VertigoCerebellumOtoliths
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 134 , Issue 1 , January 2020 , pp. 86 - 89
Copyright
Copyright © JLO (1984) Limited, 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr M Mion takes responsibility for the integrity of the content of the paper

References

1Choi, KD, Shin, HK, Kim, JS, Kim, SH, Choi, JH, Kim, HJ et al. Variants of windmill nystagmus. J Neurol 2016;263(suppl 7):1375–8110.1007/s00415-016-8152-xCrossRefGoogle ScholarPubMed
2Sanders, MD, Glaser, JS. Alternating windmill nystagmus. In: Smith, JL, ed. Neuro-ophthalmology. St Louis: Mosby, 1973;133–6Google Scholar
3Lee, SU, Jo, SY, Kim, HJ, Choi, JY, Kim, JS. Windmill nystagmus in a patient with subacute visual loss. J Neurol 2018;265(suppl 11):2737–910.1007/s00415-018-9015-4CrossRefGoogle Scholar
4Robinson, DA. The use of control system analysis in the neurophysiology of eye movements. Ann Rev Neurosci 1981;4:463–50310.1146/annurev.ne.04.030181.002335CrossRefGoogle ScholarPubMed
5Dow, ER, Anastasio, TJ. Instabilities in eye movement control: a model of periodic alternating nystagmus. In: Jordan, MI, Kearns, MJ, Solla, SA, eds. Advances in Neural Information Processing Systems 10. Cambridge, MA: MIT Press, 1998;138–44Google Scholar
6Yakushin, SB, Raphan, T, Cohen, B. Coding of velocity storage in the vestibular nuclei. Front Neurol 2017;8:38610.3389/fneur.2017.00386CrossRefGoogle ScholarPubMed
7Bertolini, G, Bockisch, CJ, Straumann, D, Zee, DS, Ramat, S. Do humans show velocity-storage in the vertical rVOR? Prog Brain Res 2008;171:207–1010.1016/S0079-6123(08)00628-6CrossRefGoogle ScholarPubMed
8Raphan, T, Cohen, B. Organizational principles of velocity storage in three dimensions: the effect of gravity on cross-coupling of optokinetic after-nystagmus. Ann N Y Acad Sci 1988;545:74–9210.1111/j.1749-6632.1988.tb19556.xCrossRefGoogle ScholarPubMed
9Chiu, B, Hain, TC. Periodic alternating nystagmus provoked by an attack of Meniere's disease. J Neuroophthalmol 2002;22:107–910.1097/00041327-200206000-00009CrossRefGoogle ScholarPubMed
10Murofushi, T, Chihara, Y, Ushio, M, Iwasaki, S. Periodic alternating nystagmus in Meniere's disease: the peripheral type? Acta Otolaryngol 2008;128:824–710.1080/00016480701714327CrossRefGoogle ScholarPubMed
11Kim, SH, Chung, WK, Kim, BG, Hwang, CS, Kim, MJ, Lee, WS. Periodic alternating nystagmus of peripheral vestibular origin. Laryngoscope 2014;124(suppl 4):980–310.1002/lary.24355CrossRefGoogle ScholarPubMed
12Daroff, RB, Dell'Osso, LF. Periodic alternating nystagmus and the shifting null. Can J Otolaryngol 1974;3(suppl 3):367–71Google Scholar

Comacchio et al. supplementary material

Comacchio et al. supplementary material 1

Download Comacchio et al. supplementary material(Video)
Video 15.2 MB

Comacchio et al. supplementary material

Comacchio et al. supplementary material 2

Download Comacchio et al. supplementary material(Video)
Video 138.3 MB