Abstract
Downbeat nystagmus in the primary gaze position, or more particularly on lateral gaze, is often accompanied by oscillopsia and postural instability. This is a clearly defined and often permanent association of symptoms, which is almost entirely specific to structural lesions of the paramedian craniocervical junction (Cogan 1968). It involves eye-head coordination in the pitch plane, mediated by pathways from the vertical semicircular canals and the otoliths. This is not a pure oculomotor disorder, but a central vestibular disorder that affects perception and balance. Differential diagnoses include gaze-evoked nystagmus, acquired pendular nystagmus, spasmus nutans and rare vertical forms of congenital nystagmus; in coma, downbeat nystagmus should not be confused with ocular bobbing. Downbeat nystagmus differs from these other conditions in that it is a spontaneous jerk nystagmus which is activated by lateral gaze, and is not suppressed by fixation.
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© 1991 Springer-Verlag London Limited
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Brandt, T. (1991). Downbeat Nystagmus/Vertigo Syndrome. In: Vertigo: Its Multisensory Syndromes. Clinical Medicine and the Nervous System. Springer, London. https://doi.org/10.1007/978-1-4471-3342-1_7
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DOI: https://doi.org/10.1007/978-1-4471-3342-1_7
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