Head-Shaking Aids in the Diagnosis of Acute Audiovestibular Loss due to Anterior Inferior Cerebellar Artery Infarction
- Alternative Author(s)
- Lee, Hyung
- Publication Year
- Objective: To determine the patterns and diagnostic value
of head-shaking nystagmus (HSN) in patients with acute audiovestibular
loss. Method: Eighteen patients underwent
evaluation of spontaneous nystagmus, gaze-evoked nystagmus,
HSN, head impulse test, ocular tilt reaction, subjective
visual vertical, bithermal caloric tests, and pure-tone audiogram.
The findings were compared with those of 21 patients
with labyrinthitis. Results: Fifteen patients (83%) exhibited
HSN, and the horizontal HSN usually beat contralesionally
(10/14, 71%). However, 9 (50%) patients also showed patterns
of central HSN that included perverted HSN (n = 7), HSN in
the opposite direction of spontaneous nystagmus (n = 4),
and HSN beating towards unilateral canal paresis or abnormal
head impulse testing (n = 3). Overall, central HSN, gazeevoked
nystagmus, and normal head impulse testing were
specific for anterior inferior cerebellar artery (AICA) infarction.
Moreover, central HSN was the only sign that indicated
stroke in 1 of our patients with isolated audiovestibular syndrome.
Lesion subtraction analyses revealed that damage tothe flocculus was relatively frequent in patients with perverted
HSN. Conclusions: In AICA infarction, HSN was common
with both peripheral and central patterns. Careful evaluation
of HSN may provide clues for AICA infarction in patients with
acute audiovestibular loss. Copyright © 2012 S. Karger AG, Basel
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