Altered vision during motion: an unusual symptom of cerebellar dysfunction, quantifiable by a simple clinical test.
OBJECTIVE
To report a series of patients with cerebellar dysfunction and altered vision during motion, and to quantify their visual impairment in motion with a simple clinical test.


METHODS
Twenty consecutive patients suffering from cerebellar dysfunction and altered vision during motion were examined between 1994 and 2007. A control group consisted of 20 age- and sex-matched healthy people. All patients had a full neuro-ophthalmic examination. Near visual acuity (NVA) was measured at rest (static NVA) and during chair rotation (dynamic NVA). Distance visual acuity (DVA) was measured at rest (static DVA) and during rotation of the patient's head (dynamic DVA).


RESULTS
Only four of the 20 patients reported altered vision during motion spontaneously. The remaining 16 patients admitted this unusual visual disturbance only when asked specifically. All patients exhibited abnormal eye movements, including saccadic smooth pursuit (20/20), dysmetric saccades (15/20), nystagmus (19/20) and impaired suppression of vestibulo-ocular reflex (VOR) (20/20). During rotation of the examination chair (dynamic NVA), the drop in NVA averaged 5.6 lines (range 1-10 lines). During rotation of the patient's head (dynamic DVA), the drop in DVA averaged only 2.5 lines (range 0-10 lines). For the control group, there was no significant drop in NVA under dynamic conditions.


CONCLUSIONS
Patients with cerebellar dysfunction rarely complain spontaneously of altered vision during motion. However, specific questioning may bring up this unusual symptom. The use of a simple clinical test, consisting of NVA measurement during rotation of the examination chair (dynamic NVA), allows practitioners to quantify the level of visual impairment in patients presenting altered VOR modulation.
Kaeser
Pierre-François
PF
Jules Gonin University Eye Hospital, University of Lausanne, Switzerland.
Borruat
François-Xavier
FX
D000293:Adolescent; D000328:Adult; D000368:Aged; D002526:Cerebellar Diseases / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006257:Head; D006801:Humans; D008297:Male; D008875:Middle Aged; D009038:Motion; D009759:Nystagmus, Pathologic; D015835:Ocular Motility Disorders / Q000209:etiology* / Q000503:physiopathology; D011698:Pursuit, Smooth; D012027:Reflex, Vestibulo-Ocular; D012399:Rotation; D012438:Saccades; D014786:Vision Disorders / Q000209:etiology*; D014792:Visual Acuity