title: Impaired Tilt Suppression of Post-Rotatory Nystagmus and Cross-Coupled Head-Shaking Nystagmus in Cerebellar Lesions: Image Mapping Study.
abstract: We sought to determine the cerebellar structures responsible for tilt suppression of post-rotatory nystagmus. We investigated ocular motor findings and MRI lesions in 73 patients with isolated cerebellar lesions who underwent recording of the vestibulo-ocular reflex (VOR) using rotatory chair tests. Tilt suppression of post-rotatory nystagmus was diminished in 27 patients (27/73, 37.0 %). The gains of the VOR and the TCs of per- and post-rotatory nystagmus did not differ between the patients with diminished and with normal tilt suppression. The patients with impaired tilt suppression showed perverted ("cross-coupled") head-shaking nystagmus (pHSN) and central positional nystagmus (CPN) more frequently than those with normal responses. Tilt suppression was impaired in five (71.4 %) of the seven patients with isolated nodulus and uvular infarction. Probabilistic lesion-mapping analysis showed that the nodulus and uvula are responsible for tilt suppression. Impaired tilt suppression may be ascribed to disruption of cerebellar contribution to the vestibular velocity-storage mechanism, which integrates information from the semicircular canals and otolith organs to help derive the brain's estimate of the head orientation relative to the pull of gravity.
authors.affiliation: Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, South Korea.
authors.forename: Sun-Uk
authors.initials: SU
authors.lastname: Lee
authors.affiliation: Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
authors.forename: Jeong-Yoon
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Biomedical Laboratory Science, Kyungdong University, Goseong-gun, Gangwon-do, South Korea.
authors.forename: Hyo-Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Konkuk University School of Medicine, Konkuk University Hospital, Seoul, South Korea.
authors.forename: Jeong-Jin
authors.initials: JJ
authors.lastname: Park
authors.affiliation: Department of Neurology, Otolaryngology Head and Neck Surgery, Neuroscience, and Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Zee
authors.affiliation: Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea. jisookim@snu.ac.kr.
authors.forename: Ji-Soo
authors.initials: JS
authors.lastname: Kim
mesh_terms: D002531:Cerebellum / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D002544:Cerebral Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D053483:Eye Movement Measurements; D005260:Female; D019416:Head Movements / Q000502:physiology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009760:Nystagmus, Physiologic / Q000502:physiology*; D010812:Physical Stimulation; D012027:Reflex, Vestibulo-Ocular / Q000502:physiology*; D012189:Retrospective Studies; D012399:Rotation; D015837:Vestibular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D014741:Video Recording
keywords: Nodulus; Nystagmus; Uvula; Vertigo; Vestibulo-ocular reflex