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Acute vertical pendular nystagmus: eye-movement analysis and review of the literature

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Abstract

Vertical pendular nystagmus (PN) rarely occurs with acute pontine lesions. To hypothesize a pathophysiology for acute vertical PN, we analyzed the clinical characteristics and quantitative eye-movement recordings of one new case with acute vertical PN and an additional 11 patients from the literature. Most patients had extensive pontine lesions causing either the locked-in syndrome or unresponsiveness, but two conscious patients had focal lesions restricted to the paramedian caudal pontine tegmentum. All patients presented a complete or partial horizontal gaze palsy, and about half showed ocular bobbing before or during the appearance of vertical PN. The vertical oscillations were conjugate at a frequency of 1–5 Hz, and the amplitudes were variable, ranging from 0.2° to 40°. The peak velocities were asymmetric in some patients, faster with downward movements. About half of the patients developed palatal tremor several weeks or months after presenting with acute vertical PN. Based on the location of the lesions and results of eye-movement recordings, we suggest two possible mechanisms for acute vertical PN; oscillations originating in the inferior olives due to disruption of the central tegmental tract or low-velocity saccadic oscillations caused by omnipause neuron damage.

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Acknowledgements

We thank Dr. HA Kim for sharing the raw data of acute vertical pendular nystagmus in her previous report to us for quantitative analysis.

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Authors and Affiliations

  1. Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Kumo-ro 20, Beomo-ri, Mulgum-eup, Yangsan, Gyeongnam, 50612, South Korea

    Eun Hye Oh, Hyun Sung Kim & Jae-Hwan Choi

  2. Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea

    Seo Young Choi & Kwang-Dong Choi

  3. Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea

    Hyo Jung Kim

  4. Department of Neurology, Ophthalmology, Otolaryngology-Head and Neck Surgery, and Neuroscience, Johns Hopkins Hospital, Baltimore, MD, USA

    David S. Zee

Authors
  1. Eun Hye Oh
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  2. Hyun Sung Kim
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  3. Seo Young Choi
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  4. Kwang-Dong Choi
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  5. Hyo Jung Kim
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  6. David S. Zee
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  7. Jae-Hwan Choi
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Contributions

EHO analyzed and interpreted the data and wrote the manuscript. Drs. HSK, SYC, KDC, HJK and DSZ analyzed and interpreted the data. Dr. JH Choi designed and conceptualized the study, interpreted the data, and revised the manuscript.

Corresponding author

Correspondence to Jae-Hwan Choi.

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All authors report no disclosures.

Ethical approval

This study followed the tenets of the Declaration of Helsinki, and was approved by the Institutional Review Boards of Pusan National University Yangsan Hospital (05-2022-121).

Supplementary Information

Below is the link to the electronic supplementary material.

Video During visual fixation, conjugate vertical pendular nystagmus (PN) with small horizontal oscillations is observed in both eyes. Intermittently, there are spontaneous bursts of abducting saccades in the right eye and a slow, small adduction movement in the left eye, followed by a slow return toward the initial position, consistent with single saccadic pulse (SSP). The vertical PN is briefly attenuated during a SSP or after eye blinking, but augmented during upward and downward gaze (WMV 19939 kb)

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Oh, E.H., Kim, H.S., Choi, S.Y. et al. Acute vertical pendular nystagmus: eye-movement analysis and review of the literature. J Neurol 269, 6642–6647 (2022). https://doi.org/10.1007/s00415-022-11314-5

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  • DOI: https://doi.org/10.1007/s00415-022-11314-5

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