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Neurology 2001;57:887-889
© 2001 American Academy of Neurology
Brief Communications

Perverted head-shaking nystagmus: A possible mechanism

Alireza Minagar, MD;, William A. Sheremata, MD; and Ronald J. Tusa, MD, PhD

From the Department of Neurology (Drs. Minagar and Sheremata), University of Miami School of Medicine, FL; and the Department of Neurology and Yerkes Research Center (Dr. Tusa), Emory University School of Medicine, Atlanta, GA.

Address correspondence and reprint requests to Dr. Ronald J. Tusa, Department of Neurology and Yerkes Research Center, Emory University, 1441 Clifton Road, NE, Atlanta, GA 30322; e-mail: rtusa{at}emory.edu

The authors describe a patient with acute MS who developed vertigo (tumbling) and downbeat nystagmus upon horizontal head oscillation (perverted head-shaking nystagmus). The only abnormality on brain MRI was a hyperintense signal in the caudal medulla that contains the nucleus Roller and nucleus intercalatus. These nuclei project to structures involved in the velocity storage system for horizontal vestibulocular reflex (VOR) and vertical VOR, and also to the vestibular cerebellum. The authors offer possible mechanisms for perverted nystagmus in this patient.




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