Cases reported "Cerebellar Diseases"

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11/41. Downbeat nystagmus following classical heat stroke.

    Cerebellar syndrome following classical heat stroke is rare. We report a case of a 39-year-old man who presented with a cerebellar syndrome including downbeat nystagmus. MRI taken after 3 days of admission was normal. The downbeat nystagmus lasted for 6 days and than gradually disappeared. The ataxia and dysmetria improved gradually over 2 months. A brain CT scan performed 3 months later revealed no cerebellar atrophy. This case is unique as there were no predisposing factors (e.g. hypomagnesemia) and follow-up revealed complete reversibility of the ophthalmological abnormality. It reveals that the vestibulocerebellum is particularly vulnerable to thermal injury.
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12/41. Clinical presentation of posterior fossa epidermoid cysts.

    The aim of this study was to investigate the audiovestibular deficits in those with posterior fossa epidermoid cyst including cerebellopontine angle in two patients and cerebellum in one patient. Prior to operation, all three patients showed bilateral gaze nystagmus. audiometry revealed mild hearing loss in two patients, and caloric test displayed canal paresis in two patients. After operation, subsidence of gaze nystagmus and recovery of caloric responses were disclosed in all patients. Two patients had both hearing and vestibular evoked myogenic potential (VEMP) results recovered to normal. In contrast, the only one who underwent craniotomy twice displayed bilateral mild hearing loss and delayed VEMPs, possibly due to operation sequela. Hence, bilateral gaze nystagmus may present as an initial sign for posterior fossa epidermoid cyst. Audiovestibular deficits in cases of epidermoid cyst are attributable to compression neuropathy, which may resolve and return to normal responses after surgery.
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13/41. Positional nystagmus and vertigo due to a solitary brachium conjunctivum plaque.

    The authors describe two patients suffering from demyelinating central nervous system disease who developed intense vertigo and downbeat nystagmus upon tilting their heads relative to gravity. brain MRI revealed in both cases a single, small active lesion in the right brachium conjunctivum. The disruption of otolithic signals carried in brachium conjunctivum fibres connecting the fastigial nucleus with the vestibular nuclei is thought to be causatively involved, in agreement with a recently formulated model simulating central positional nystagmus. Insufficient otolithic information results in erroneous adjustment of the Listing's plane in off-vertical head positions, thus producing nystagmic eye movements.
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14/41. Prospective study of positional nystagmus in 100 consecutive patients.

    OBJECTIVES: The purpose of this study was to investigate the various diagnoses of patients who present with positional nystagmus. methods: Positional maneuvers were systematically performed in the plane of the posterior canal (PC; Dix-Hallpike maneuver) and the horizontal canal (HC; patients were rolled to either side in a supine position) on 490 consecutive patients essentially referred for vertigo and/or gait unsteadiness. RESULTS: One hundred patients (20%) presented positional nystagmus. This nystagmus had a peripheral origin in 83 patients, including 80 patients with benign paroxysmal positional vertigo (BPPV). In BPPV, the PC was involved in 61 patients, the HC in 18 patients (geotropic horizontal nystagmus in 11 and ageotropic in 7; changing from geotropic to ageotropic or the reverse in 4 patients), and both the PC and HC in 1 patient. There was evidence of central positional nystagmus in 12 patients, including positional downbeat nystagmus during the Dix-Hallpike maneuver in 7 patients with various neurologic disorders, and ageotropic horizontal nystagmus during the HC maneuver in 2 patients with, respectively, cerebellar ischemia and definite migrainous vertigo. The peripheral or central origin of the positional nystagmus could not be ascertained in 5 patients, including 1 patient with probable migrainous vertigo and another with possible anterior canal BPPV. CONCLUSIONS: A rotatory-upbeat nystagmus in the context of PC BPPV, a horizontal nystagmus, whether geotropic or ageotropic, due to HC BPPV, and a positional downbeat nystagmus related to various central disorders are the 3 most common types of positional nystagmus. Geotropic horizontal positional nystagmus and, most certainly, horizontal positional nystagmus changing from geotropic to ageotropic or the reverse point to HC BPPV. In contrast, an ageotropic horizontal positional nystagmus that is not changing (from ageotropic to geotropic) may indicate a central lesion.
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15/41. A case of acquired nystagmus alternans associated with acute cerebellitis.

    A case of acquired nystagmus alternans (alternating nystagmus) is reported. The patient was a 14-year-old boy who presented with fever and headache, followed by dysbasia, truncal ataxia, and positional vertigo. Neuro-otological examinations revealed spontaneous downbeat nystagmus, bilateral gaze nystagmus and rebound nystagmus. Both cell count and protein volume were elevated in the cerebrospinal fluid, and a diagnosis of cerebellitis was made. About one month later, nystagmus alternans was observed, but it disappeared after 7 months. The presence of spontaneous downbeat nystagmus, rebound nystagmus, as well as cerebellar signs indicated that a cerebellar lesion was mainly responsible for the nystagmus alternans in this patient.
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16/41. Cavernous angioma of the cerebellum--case report.

    Computed tomography (CT) allows earlier diagnosis of intracranial cavernous angioma than was formerly possible. However, cerebellar lesions are uncommon. Cerebellar cavernous angioma with hemorrhage was diagnosed in a 54-year-old male who suddenly developed nausea and vomiting, then declined over the following week and developed ataxia and nystagmus. blood pressure was normal, and he had no history of hypertension or hemorrhagic diathesis. Precontrast CT revealed an irregularly-shaped, hyperdense lesion in the left cerebellum and an associated hematoma. Injection of contrast medium did not significantly enhance the lesion. Vertebral angiography demonstrated only an avascular mass in the cerebellum. A semiliquid hematoma was evacuated and a vascular nodule was removed from the posterior wall of the hematoma cavity. The histopathological diagnosis was cavernous angioma. Nine sufficiently documented reports of cerebellar cavernous angioma are reviewed and the clinical and radiological features of these lesions are discussed.
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17/41. Familial vestibulocerebellar dysfunction: a new syndrome?

    Three members of a single family with the symptom of "motion sickness" showed rebound nystagmus, saccadic pursuit eye movements, defective optokinetic slow phase velocity and lack of fixation suppression of vestibularly induced nystagmus. One of them showed vestibular hyperreactivity and a gradual build-up of the optokinetic response. In absence of other abnormalities, these findings can be localized to the vestibulocerebellum (flocculo-nodular lobe).
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18/41. A case of lithium intoxication with downbeat vertical nystagmus.

    lithium carbonate has recently been used in the treatment of manic diseases. However, since the marginal range between therapeutic and toxic doses is very narrow, close attention should be paid to the development of adverse reactions in its application. Lithium intoxication is manifested by neurological symptoms. Neurotological tests were performed on a patient with lithium intoxication that occurred in the course of psychiatric treatment of mania. The observed sequelae included marked downbeat vertical nystagmus and truncal ataxia. The main lesions in the present case were considered to be located in the cerebellum. Close observation, including neurotological tests, is of greatest importance because in cases of lithium intoxication the development of cerebellar as well as brainstem disorders must not be overlooked.
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19/41. arnold-chiari malformation--some otoneurological features.

    arnold-chiari malformation was diagnosed in five patients with vertigo. Four were of anatomical type I. A case report is given of one patient who presented features of a unilateral cerebellopontine angle lesion. Downward beating vertical nystagmus was an important finding in three of the five patients. Other clinical and radiological features of the condition are discussed.
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20/41. Ovarian carcinoma and paraneoplastic cerebellar degeneration.

    A case of paraneoplastic cerebellar degeneration complicating ovarian cancer is presented. This rare disorder is characterized by vertigo, nystagmus, diplopia, and ataxia. Neurologic sequelae are progressive, ultimately culminating in complete incapacitation and death. Symptoms of paraneoplastic cerebellar degeneration precede the diagnosis of malignancy in the majority of cases. Marked elevation in the anti-Purkinje cell antibody titer together with immunofluorescent staining techniques suggest that an autoimmune mechanism plays a role in the etiology of this disorder.
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