수직성 안진
강봉희
단국대학교병원 신경과
Vertical nystagmus 수직성 안진
강봉희 단국대학교병원 신경과
Vertical nystagmus
• Upbeating or downbeating
• In the straight-ahead positon of gaze (primary position)
• DDx : vertical gaze evoked nystagmus perverted head shaking nystagmus positional nystagmus
Hypothetical pathophysiology of vertical nystagmus
• Still not understood
• Experimental data
• Clinical findings: the main clinical focal lesions
1. Vertical neural integrator dysfunction: gaze hold system
2. Vertical VOR imbalance (central vestibulopathy)
3. Abnormal vertical smooth pursuit system
The SVN-VTT pathway
• ventral tegmental tract (VTT)
• Transmitting excitatory upward vestibular signals from AC
• Specific cerebellar floccular inhibition
• No equivalent for the VTT for the downward vestibular system
• To counteract the gravity pull
• Associated with a physiological upward velocity bias
UBN in pons lesions
C. Tilikete et al. J Neuro-Ophthalmol 2008;28:202–206
UBN & WEBINO
DS Park et al. Research in Vestibular Science Vol.
13, No. 1, March 2014
UBN & INO
Adduction deficit in the right eye on leftward gaze
N A R Munro et al. J of Neurology, Neurosurgery, and Psychiatry
1993;56:1126-1128
UBN
HA Kim, H Lee. Clin Neuroophthalmol 1(1):79-81, June 2011
UBN
J C Janssen et al. (J Neurol Neurosurg Psychiatry 1998;65:380–381) C. Pierrot-Deseilligny and D. Milea. Brain (2005), 128, 1237–1246
R. Kalla et al. Neurology 2006;66:281-283
Detection of floccular hypometabolism in downbeat nystagmus by fMRI
The authors evaluated floccular activity with fMRI during the performance of vertical smooth pursuit eye movements in four patients with downbeat nystagmus (DBN) due to cerebellar degeneration and in 16 healthy controls. Region of interest analysis revealed a significantly diminished activation of both floccular lobes during downward but not upward pursuit in DBN.
These imaging data support the view that a functional deficiency of the flocculi in downward pursuit causes DBN
DBN & INO
Kiyotaka Nakamagoe et al. Journal of the Neurological Sciences 328 (2013) 98–101
DBN PMT cells
Kiyotaka Nakamagoe et al.
Journal of Clinical Neuroscience 19 (2012) 1597–1599
