Imperial College London
Alternate

ProfessorAdolfoBronstein

Faculty of Medicine, Department of Brain Sciences

Emeritus Clinical Professor Head of Neuro-otology Unit
 
 
 
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Contact

 

+44 (0)20 3313 5525a.bronstein

 
 
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Assistant

 

Miss Lorna Stevenson +44 (0)20 3313 5525

 
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Location

 

10 L15bLab BlockCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Kaski:2018:10.3389/fneur.2018.00326,
author = {Kaski, DN and Haider, S and Male, A and Liu, F and Radunovic, A and Cordivari, C and Bhatia, K and Bronstein, AM},
doi = {10.3389/fneur.2018.00326},
journal = {Frontiers in Neurology},
title = {Adult periodic alternating nystagmus masked by involuntary head movements: a case report},
url = {http://dx.doi.org/10.3389/fneur.2018.00326},
volume = {9},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - A 20-year-old previously well female presented with a history of abrupt onset recurrent episodic (seconds) “dizziness” characterized by a shimmering of the world in front of her. By day 3 she began to experience a constant sensation of vertigo, oscillopsia, mild headache, and prominent vomiting. She was afebrile, had no neck stiffness, but described photophobia. She had gradually developed an involuntary mild side-to-side continuous head movement by day 3. On day 6 there was a constant “no-no” head movement with variable frequency (circa. 2–4 Hz) and amplitude (circa. 15° peak-to-peak) and initially had a fast phase component to the right, with occasional oblique movements (Video S1 in Supplementary Material). The family reported that the movement disappeared during sleep. On admission to hospital, there was right-beating nystagmus (RBN) in the primary position intensifying  on  right  gaze  and  also  apparent  on  upgaze  (Video  S1  in  Supplementary  Material).  The  intensity  of  the  nystagmus  was  enhanced  during  positional  maneuvers,  without  a  change  in  nystagmus  direction.  Oculographic  recordings  were  not  available  acutely.  The  gait  was  unsteady,  with  asymmetric  step  length,  inconsistent  foot  placement,  and  variable  left  foot  intorsion,  sug-gesting  a  functional  (psychogenic)  etiology  (Video  S2  in  Supplementary  Material).  There  was  no  limb  ataxia,  and  no  myoclonus.  Ten  days  after  the  original  assessment  the  head  movements  worsened dramatically, rendering interpretation of the eye movements difficult (Figure 1A; Video S3 in Supplementary Material), but the patient continued to complain of oscillopsia, even when the examiner attempted to restrain the head manually (the patient did not consent to the use of a bite bar). The head tremor resolved immediately on day 21 after symptom onset with subtherapeutic 50 mouse units of abobotulinumtoxin A applied to the levator sc
AU  - Kaski,DN
AU  - Haider,S
AU  - Male,A
AU  - Liu,F
AU  - Radunovic,A
AU  - Cordivari,C
AU  - Bhatia,K
AU  - Bronstein,AM
DO  - 10.3389/fneur.2018.00326
PY  - 2018///
SN  - 1664-2295
TI  - Adult periodic alternating nystagmus masked by involuntary head movements: a case report
T2  - Frontiers in Neurology
UR  - http://dx.doi.org/10.3389/fneur.2018.00326
UR  - http://hdl.handle.net/10044/1/59271
VL  - 9
ER  -
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