Abstract Details

Title Acute Vertigo from a Unilateral Middle Cerebellar Peduncle Demyelinating Lesion

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P9 - Poster Session 9 (12:00 PM-1:00 PM)

Poster/Presentation
Number 5-005

Objective To describe acute vertigo from a unilateral middle cerebellar peduncle (MCP) demyelinating lesion.

Background The MCP is a major pathway for cortico-ponto-cerebellar connections that carry eye movement information. Unilateral MCP strokes are reported to cause acute vertigo with abnormal eye movements including spontaneous horizontal and/or torsional nystagmus, ocular tilt reaction, gaze-evoked nystagmus (GEN), abnormal head-impulse test and impaired smooth pursuit. Two-thirds of patients with MCP strokes showed GEN, indicating failure of neural integration.

Design/Methods Case Report

Results A 35-year-old woman with multiple sclerosis presented 3 months postpartum, off disease modifying therapy, with acute spinning, nausea, and a feeling of ‘drunkeness.’ Non-contrast MRI brain showed a medial right MCP diffusion-restricting lesion, consistent with an acute MS exacerbation. She was treated with steroids with minimal improvement. Ten months later, dizziness with motion continued. Exam revealed normal acuity, visual fields and color vision OU, and full ocular motor range without deterioration on dynamic acuity. On cross-cover testing there was a left hyperphoria that increased in left gaze and right head tilt, consistent with a skew deviation, and GEN (larger amplitude in right gaze). Occlusive ophthalmoscopy and horizontal headshaking unmasked right beat nystagmus. Head impulse test (HIT) was positive towards the right. Rightward pursuit was saccadic. Videonystagmography (VNG) confirmed impaired rightward pursuit, GEN, and spontaneous right-beat nystagmus suppressible with fixation. Calorics were normal. Video HIT several months after VNG and vestibular therapy suggested a left vestibulopathy. Rotary chair testing showed impaired VOR cancellation.

Conclusions

Acute unilateral middle cerebellar peduncle pathology from ischemia or demyelination can cause an acute vestibular syndrome that can mimic peripheral vestibular neuropathy. A detailed exam seeking other centrally-mediated eye movement abnormalities, such as GEN, ipsilateral saccadic pursuit and skew deviation can assist with diagnosis.

Authors/Disclosures
Scott Grossman, MD (New York University, Langone Health) PRESENTER	Dr. Grossman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Acuta Pharmaceuticals.
Erica H. Parrotta, DO (Saint Peters Health Partners MS & Headache Center)	No disclosure on file
Catherine Cho, MD (NYU Langone Medical Center)	Dr. Cho has nothing to disclose.
Stephen Krieger, MD, F�鶹��ýӳ�� (Mount Sinai Dept of Neurology)	Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Krieger has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Krieger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TG Therapeutics. Dr. Krieger has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Krieger has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cycle. The institution of Dr. Krieger has received research support from Novartis. The institution of Dr. Krieger has received research support from Bristol Myers Squibb. The institution of Dr. Krieger has received research support from Biogen. The institution of Dr. Krieger has received research support from Sanofi.
Janet C. Rucker, MD	Dr. Rucker has nothing to disclose.

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