title: Vertigo and nystagmus in orthostatic hypotension.
abstract: OBJECTIVE
  Generalized cerebral ischaemia from cardiovascular dysfunction usually leads to presyncopal dizziness, but several studies reported a higher frequency of rotatory vertigo in cardiovascular patients. Whether generalized cerebral ischaemia due to cardiovascular disorders may produce objective vestibular dysfunction was investigated.
  
  
  METHODS
  Thirty-three patients with orthostatic dizziness/vertigo due to profound orthostatic hypotension and 30 controls were recruited. All participants underwent recording of eye movements during two orthostatic challenging tests: the Schellong and the squatting-standing tests. Most patients had neuroimaging, and patients with abnormal eye movements were subjected to follow-up evaluations.
  
  
  RESULTS
  Symptoms associated with orthostatic dizziness/vertigo included blurred vision, fainting and tinnitus. Ten (30%) of 33 patients developed rotatory vertigo and nystagmus during the Schellong (n = 5) or squatting-standing test (n = 5). Four of them showed pure downbeat nystagmus whilst five had downbeat and horizontal nystagmus with or without torsional component. Patients with orthostatic nystagmus had shorter duration of orthostatic intolerance than those without nystagmus (1.0 ± 1.6 vs. 11.0 ± 9.7 months, P < 0.001). In two patients, orthostatic nystagmus disappeared during follow-up despite the persistence of profound orthostatic hypotension.
  
  
  CONCLUSIONS
  Generalized cerebral ischaemia caused by orthostatic hypotension induces rotatory vertigo due to objective vestibular dysfunction. The presence of orthostatic vertigo and nystagmus has an association with the duration of orthostatic intolerance.
authors: Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors: J-H
authors: JH
authors: Choi
authors: J-D
authors: JD
authors: Seo
authors: M-J
authors: MJ
authors: Kim
authors: B-Y
authors: BY
authors: Choi
authors: Y R
authors: YR
authors: Choi
authors: B M
authors: BM
authors: Cho
authors: J S
authors: JS
authors: Kim
authors: K-D
authors: KD
authors: Choi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications* / Q000209:etiology; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009759:Nystagmus, Pathologic / Q000209:etiology* / Q000503:physiopathology; D054971:Orthostatic Intolerance / Q000209:etiology* / Q000503:physiopathology; D014717:Vertigo / Q000209:etiology* / Q000503:physiopathology
keywords: cerebral ischaemia; nystagmus; orthostatic hypotension; orthostatic vertigo; vertebrobasilar insufficiency