Possible Causes for upbeat nystagmus Central Positional Vertigo The presumed pathophysiology for the upbeating nystagmus is thought to be the opposite of that for the downbeating nystagmus. [mhmedical.com] If the fast phase is toward the left, then it is named left horizontal nystagmus. If the fast phase is upwardly, then it is named upbeat nystagmus[ref2][ref3]. [teddybrain.wordpress.com] Upbeating Vertical Nystagmus • Two varieties: • Large amplitude nystagmus that increases in intensity with upward gaze. • Suggestive of a lesion of the anterior vermis of [slideshare.net] Benign Paroxysmal Positional Vertigo We present a case of benign paroxysmal positional vertigo (BPPV) with positive Dix-Hallpike bilaterally, but also with upbeat purely vertical nystagmus in the straight back [ncbi.nlm.nih.gov] The response rate after 1 week, defined as absence of positional vertigo and torsional/upbeating nystagmus on positional testing, was 95% in the MEP group (n 37) vs 58% in [ncbi.nlm.nih.gov] Both exhibited left torsion upbeating nystagmus in the left Dix-Hallpike (DH) test and complaints of vertigo with reproduction of their symptoms, indicating BPPV. [ncbi.nlm.nih.gov] Pineal Gland Neoplasm ICD.Codes ICD-10-CM (2016) Chapter 2 Section C73-C75 Code C75.3 BILLABLE Billable Code Billable codes are sufficient justification for admission to an acute care hospital when used a principal diagnosis. ICD-10 from 2011 - 2016 C75.3 is a billable ICD code used to specify a diagnosis of malignant neoplasm of pineal gland.[…] [icd.codes] Parinaud Syndrome To characterize the clinical features, aetiology and management of ophthalmic symptoms in adult patients with Parinaud syndrome. This is a retrospective, non-comparative observational case series. We reviewed 40 consecutive charts of adult patients with the clinical diagnosis of Parinaud syndrome at the Royal[…] [ncbi.nlm.nih.gov] Pineal Gland Dysfunction Kjell Fuxe, Jan-Åke Gustafsson, Lennart Wetterberg Elsevier, ٢٢/١٠/٢٠١٣ - 424 من الصفحات Steroid Hormone Regulation of the Brain focuses on the advancement of knowledge of the properties of brain steroid receptors and steroid target nerve cells, including the actions of gonadal steroids, adrenocortical[…] [books.google.com] Brain Stem Disorder Some of these patients have upbeating nystagmus supine, often confused with BPPV. [dizziness-and-balance.com] Upbeat nystagmus may occur. Small vessel disease (diabetes, hypertension, hypercholesterolemia) is the usual cause. Pontine hyperintense lesions. [tchain.com] Upbeat nystagmus and the ventral tegmental pathway of the upward vestibulo-ocular reflex. Neurology 1988;38:1329-1330. 3. Bhidayasiri R, Plant GT, Leigh RJ. [neuroophthalmology.ca] Hereditary Nystagmus Lithium-induced periodic alternating nystagmus. Neurology, 60,2003, 344 Central nystagmus (downbeat, upbeat nystagmus, horizontal, torsional) Upbeat nystagmus (UBN). [tchain.com] Upbeat jerk nystagmus. Upbeat nystagmus is less frequent than downbeat nystagmus. [neuroophthalmology.ca] A jerk nystagmus is usually due to a motor defect that may be induced by brainstem or cerebellar lesions, drug intoxication ( upbeat nystagmus in which the fast phase is in [medical-dictionary.thefreedictionary.com] Malnutrition The patient showed upbeating nystagmus and lateral gaze nystagmus with dizziness and ataxia. [doi.org] nystagmus Upbeat nystagmus is defined as nystagmus with the fast phase beating in an upward direction. [emedicine.medscape.com] Upbeat Nystagmus Upbeat nystagmus is purely-vertical conjugate nystagmus that manifests itself in primary gaze with slow downdrift of the eyes corrected by fast upward saccade [eyewiki.aao.org] Hyperventilation Almost nobody gets upbeating nystagmus or torsional nystagmus after hyperventilation (if they are normal), although this can happen rarely in persons with 8th nerve injury [dizziness-and-balance.com] The other 50% either have nothing, or a minor horizontal nystagmus. [dizziness-and-balance.com] In normal persons, HVIN is a low amplitude downbeating nystagmus. An example is shown below. This is not found in "100%', but roughly 50% of normals. [dizziness-and-balance.com] Posterior Inferior Cerebellar Artery Occlusion Positional testing was abnormal due to the ongoing nystagmus, but there was also a brief upbeating nystagmus. Headshaking provoked a very strong reversal of nystagmus. [dizziness-and-balance.com] Upbeat nystagmus may occur. Small vessel disease (diabetes, hypertension, hypercholesterolemia) is the usual cause. Pontine hyperintense lesions. [tchain.com] The other 3 showed seesaw, upbeat, or pure torsional nystagmus. Asymmetrical bidirectional gaze-evoked nystagmus was also found in 35 patients. [ahajournals.org] Wernicke Encephalopathy Eye-movement abnormalities reported in Wernicke’s encephalopathy include gaze-evoked nystagmus, spontaneous upbeat nystagmus, and horizontal or vertical ophthalmoplegia. [nejm.org] Conspicuous neurologic signs were upbeat nystagmus and ophthalmoplegia, indicating brainstem involvement. [doi.org] An examination revealed spontaneous upbeat nystagmus ( Video 1 ), gaze-evoked nystagmus ( Video 2 ), and gait ataxia. She had no ophthalmoplegia. [nejm.org] Superior Semicircular Canal Dehiscence and Valsalva-induced upbeat jerk nystagmus. • Superior semicircular canal dehiscence syndrome is caused by missing bone over the superior aspect of a semicircular canal, [medlink.com] Upbeating nystagmus provoked by vibration over the mastoid of person with left sided SCD. Image courtesy of Dr. Dario Yacovino. [dizziness-and-balance.com] […] superior semicircular canal dehiscence may have vertical oscillopsia and impaired vision during locomotion, disequilibrium, spontaneous pulse-synchronous vertical pendular nystagmus [medlink.com] Brain Stem Infarction Some of these patients have upbeating nystagmus supine, often confused with BPPV. [dizziness-and-balance.com] Upbeat nystagmus may occur. Small vessel disease (diabetes, hypertension, hypercholesterolemia) is the usual cause. Pontine hyperintense lesions. [tchain.com] Upbeat nystagmus may occur (as also occurs in pontine white matter disorders, see above). [dizziness-and-balance.com] Familial Progressive Vestibulocochlear Dysfunction Downbeat or upbeat nystagmus occur with SCA6 (1052). There are reductions in pursuit but not in VOR or, surprisingly, VOR-cancellation (1053). [neuroophthalmology.ca] […] a Video of a case of upbeating nystagmus due to Wernicke's encephalopathy. [tchain.com] Dysfunction of central vestibular pathways also causes downbeat (1011-1013) and less commonly upbeat nystagmus (1009). Nystagmus may be constant or intermittent (1018). [neuroophthalmology.ca] Brain Stem Hemorrhage Some of these patients have upbeating nystagmus supine, often confused with BPPV. [dizziness-and-balance.com] Upbeat nystagmus may occur (as also occurs in pontine white matter disorders, see above). [dizziness-and-balance.com] Increased white matter signal on Flair in pons, associated with upbeating nystagmus and ataxia. [dizziness-and-balance.com] Diazinon Poisoning Primary position upbeat nystagmus with organophosphate poisoning. J Pediatr Ophthalmol Strabismus 1982 ; 19 : 318 –19. Hata S, Bernstein E, Davis LE. [jnnp.bmj.com] Psychogenic Hyperventilation Almost nobody gets upbeating nystagmus or torsional nystagmus after hyperventilation (if they are normal), although this can happen rarely in persons with 8th nerve injury [dizziness-and-balance.com] The other 50% either have nothing, or a minor horizontal nystagmus. [dizziness-and-balance.com] In normal persons, HVIN is a low amplitude downbeating nystagmus. An example is shown below. This is not found in "100%', but roughly 50% of normals. [dizziness-and-balance.com] Cerebellar Stroke Some of these patients have upbeating nystagmus supine, often confused with BPPV. [dizziness-and-balance.com] Upbeat nystagmus may occur (as also occurs in pontine white matter disorders, see above). [dizziness-and-balance.com] Increased white matter signal on Flair in pons, associated with upbeating nystagmus and ataxia. [dizziness-and-balance.com] Obstructive Sleep Apnea nystagmus Upbeat nystagmus is defined as nystagmus with the fast phase beating in an upward direction. [emedicine.medscape.com] Upbeat Nystagmus Upbeat nystagmus is purely-vertical conjugate nystagmus that manifests itself in primary gaze with slow downdrift of the eyes corrected by fast upward saccade [eyewiki.aao.org] Symmetrical vertical nystagmus Upbeat nystagmus: This is a jerk nystagmus with the fast phase going upwards. [patient.info] Meige Syndrome In a patient with Brueghel syndrome, paroxysmal hyperpnea coincided with dystonic gaping; the finding of upbeating nystagmus suggests pontine localization in the pathogenesis [ncbi.nlm.nih.gov] There is paroxysmal hyperpnoea (increased depth of breathing) and upbeating nystagmus. [nhp.gov.in] Familial Congenital Palsy of Trochlear Nerve Nystagmus Syndrome Latent Nystagmus - Acquired Vertical Upbeat Primary Position Gaze Evoked Downbeat Primary Position Gaze Evoked Horizontal Primary Position Gaze Evoked Special [repository.countway.harvard.edu] FRCP Harvard Medical School Upbeat Nystagmus Shirley H. Wray, M.D. Ph.D. FRCP Harvard Medical School Visual Neglect Shirley H. Wray, M.D. Ph.D. [repository.countway.harvard.edu] FRCP Harvard Medical School Paraneoplastic Upbeat Nystagmus Shirley H. Wray, M.D. Ph.D. FRCP Harvard Medical School Parasellar Meningioma Shirley H. Wray, M.D. Ph.D. [repository.countway.harvard.edu] Ondine Syndrome The neurological examination revealed upbeat nystagmus of small amplitude in the primary position which did not change with upward or downward gaze. [baillement.com] Idiopathic Bilateral Vestibulopathy […] canal BPPV: the Dix-Hallpike maneuver reveals upbeating-tortional nystagmus 6 horizontal canal BPPV: the log-roll maneuver reveals purely horizontal nystagmus 6 anterior [radiopaedia.org] This should not be of any concern as long as it is unaccompanied by upbeating nystagmus on sitting (which suggests anterior canal BPP V). [dizziness-and-balance.com] nystagmus. [27] These drug therapies offer symptomatic treatment, and do not affect the disease process or resolution rate. [en.wikipedia.org] Demyelinating Disease We present a 45-year-old female patient with paroxysmal symptoms of dysarthria, right-sided ataxia, and a persistent symptom of upbeating nystagmus. [jkna.org] There were right sided cerebellar signs and upbeat nystagmus. The tone was reduced with brisk reflexes and extensor plantar responses. Her sensation was normal. [jnnp.bmj.com] Nothnagel Syndrome Specific types of nystagmus and their localizing value(1) Down beat nystagmus Upbeat nystagmus Rebound nystagmus Brun's nystagmus Periodic alternating Convergence retraction [medicine.uiowa.edu] Some of these patients have upbeating nystagmus supine, often confused with BPPV. [dizziness-and-balance.com] In rare instances, upbeat nystagmus may be present [ 173 ]. A crossed motor hemiparesis (hemiplegia cruciata) is an extremely rare occurrence [ 39 ]. [neupsykey.com] Migraine When nystagmus is present, it is often directed vertically (e.g. upbeating or downbeating). [dizziness-and-balance.com] We agree with this -- especially pure upbeating supine. We also think there is more downbeating upright. [dizziness-and-balance.com] When patients are examined acutely when vertiginous, there is usually minimal or no spontaneous nystagmus. [dizziness-and-balance.com] Klinefelter Syndrome We present a 45-year-old female patient with paroxysmal symptoms of dysarthria, right-sided ataxia, and a persistent symptom of upbeating nystagmus. [jkna.org] Internal Auditory Artery Occlusion Some of these patients have upbeating nystagmus supine, often confused with BPPV. [dizziness-and-balance.com] Upbeat nystagmus may occur (as also occurs in pontine white matter disorders, see above). [dizziness-and-balance.com] Increased white matter signal on Flair in pons, associated with upbeating nystagmus and ataxia. [dizziness-and-balance.com] Disorder of Basilar Artery Some of these patients have upbeating nystagmus supine, often confused with BPPV. [dizziness-and-balance.com] Upbeat nystagmus may occur (as also occurs in pontine white matter disorders, see above). [dizziness-and-balance.com] Increased white matter signal on Flair in pons, associated with upbeating nystagmus and ataxia. [dizziness-and-balance.com] Bickerstaff Brainstem Encephalitis There was upbeating nystagmus on upward gaze, and bilateral horizontal gaze‐evoked nystagmus. His pupils were dilated and light reflexes were absent. [doi.org]
