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    The Individual Components Can Differ1

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    Kharisma Setya Harnani
    The document discusses various types of nystagmus including downbeat and upbeat nystagmus. Downbeat nystagmus is often caused by lesions in the flocculus, paraflocculus, or bottom of the fourth ventricle. Upbeat nystagmus is rarer and associated with lesions in the medulla oblongata or brainstem. Treatment may involve medications like 4-aminopiridine or gabapentin.

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    The Individual Components Can Differ1

    Uploaded by

    Kharisma Setya Harnani
    18 views2 pages
    The document discusses various types of nystagmus including downbeat and upbeat nystagmus. Downbeat nystagmus is often caused by lesions in the flocculus, paraflocculus, or bottom of the fourth ventricle. Upbeat nystagmus is rarer and associated with lesions in the medulla oblongata or brainstem. Treatment may involve medications like 4-aminopiridine or gabapentin.

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    The document discusses various types of nystagmus including downbeat and upbeat nystagmus. Downbeat nystagmus is often caused by lesions in the flocculus, paraflocculus, or bottom of the fourth ventricle. Upbeat nystagmus is rarer and associated with lesions in the medulla oblongata or brainstem. Treatment may involve medications like 4-aminopiridine or gabapentin.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    18 views2 pages

    The Individual Components Can Differ1

    Uploaded by

    Kharisma Setya Harnani
    The document discusses various types of nystagmus including downbeat and upbeat nystagmus. Downbeat nystagmus is often caused by lesions in the flocculus, paraflocculus, or bottom of the fourth ventricle. Upbeat nystagmus is rarer and associated with lesions in the medulla oblongata or brainstem. Treatment may involve medications like 4-aminopiridine or gabapentin.

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    of 2

    The individual components can differ, since there are probably other

    pathogenesis besides the vestibular one with imbalance in the graviceptive VOR
    (impairment in the projection of ctolithic information). E.g. imbalance disfunction
    of the neuronal ocular motor integrator and of the saccade-burst generator.
    Downbeat nystagmus is often the result of a bilateral lesion of the flocculus or
    the paraflocculus (ex intoxication due to anticonvulsant drugs) or caused by a
    lesion at the bottom of the fourth ventricle. Accordingly it is mostly a druginduced dysfunction or congenital (Arnold-Chiari malformation), 20% have
    cerebellar degeneration and more seldom lesions of the medulla oblongata, and
    by MS, haemorrhage, infarctionor tumour for example. A downbeat nystagmus
    due to a lesion in the upper medulla at the level of the rostral nucleus
    praepositus hypoglossi has so far only been reported in monkeys, not in human.
    Upbeat nystagmus is rarer than downbeat nystagmus. It is also a fixation
    induced nystagmus that beats upward in primary gaze position and is combined
    with a disorder of the vertical smooth-pursuit eye movements, a visual and
    vestibulospinal ataxia with a tendency to fall backward, and past pointing
    downward.
    On the one hand, the pathoanatomic location of most acute lesions is
    paramedian in medulla oblongata in neurons of the paramedia tract, close the
    caudalpart of the perihypoglossal nucleus, which is responsible for vertical gaze
    holding. On the other hand, lesions have been reported paramedian paramedian
    in tegmentum of the pontomescencephalic junction, the brachium conjunctivum
    and probably in the anterior vermis. The symptoms persist as a rule for several
    weeks but are not permanent. Because the eye movement generally have larger
    amplitudes, oscillopsia in upbeat nystagmus is very distressing and impairs
    vision. Upbeat nystagmus due to damage of the pontomesencephalic brainsteam
    is frequently combined with a unilateral or bilateral internuclear ophtalmoplegia,
    indicating that the MLF is affected. The main aetiologies are bilateral lesions in
    MS, brainsteam ischemia or tumour, wernickes encephalopathy cerebellar
    degeneration and dysfunction of the cerebellum due to intoxication.
    The course and prognosis depend on the underlying illness. It is
    therapeutically expedient to attempt treatment of the symptoms of persisting
    downbeat or upbeat nystagmus syndrome by administering 4-aminopiridine,
    gabapentin, baclofen, clonazepam.
    Vestibular syndromes in the vertical (roll) plane
    -

    These syndrome indicate an acute unilateral deficit of the graviceptive


    vestibular pathways, which run from the vertical canals and otoliths over
    the ipsilateral (medial and superior) vestibular nuclei and the contralateral
    MLF to the ocular motor nuclei and integration centres for vertical and
    torsional eye movements (INC and riMLF) in the rostral mid-brain.

    Most rostral to the midbrain, only the vestibular projection of the VOR for
    perception in the roll plane (determination of the subjective visual vertical,
    SVV) runs over the vestibular nuclei in the posterolateral thalamus to the
    parietoinsular vestibular cortex in the posterior insula. The crossing of
    these pathways at pontine level is especially important for topographic
    diagnosis of the brainsteam.

    All signs of lesions in the roll plane-single components or a complete


    ocular tilt reaction (head tilt, vertical divergence of the eyes, ocular
    torsion, SVV deviation).

    Setiap individu dapat berbeda, karena mungkin ada patogenesis selain


    masalah vestibular dengan ketidakseimbangan dalam VOR graviceptive
    (penurunan proyeksi otolithic).

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