Radtke A, Bronstein A M, Gresty M A, Faldon M, Taylor W, Stevens J M, Rudge P
MRC Human Movement and Balance Unit, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
J Neurol Neurosurg Psychiatry. 2001 Jun;70(6):790-3. doi: 10.1136/jnnp.70.6.790.
A patient with suspected brain stem glioma involving the area of the left vestibular nuclei and cerebellar peduncle, developed paroxysmal alternating skew deviation and direction changing nystagmus after biopsy of the inferior cerebellar vermis resulting in destruction of the uvula. Between attacks she had right over left skew deviation with asymptomatic right beating horizontal nystagmus. Slow phases of the resting nystagmus showed increasing velocity, similar to congenital nystagmus. At intervals of 40-50 seconds, paroxysmal reversal of her skew deviation occurred, accompanied by violent left beating horizontal torsional nystagmus lasting 10-12 seconds and causing severe oscillopsia. It is proposed that this complex paroxysmal eye movement disorder results from (1) a lesion in the left vestibular nuclei causing right over left skew and right beating resting nystagmus and (2) a disruption of cerebellar inhibition of vestibular nuclei, causing alternating activity in the vestibular system with intermittent reversal of the skew deviation and paroxysmal nystagmus towards the side of the lesion.
一名疑似脑干胶质瘤累及左侧前庭核和小脑脚区域的患者，在小脑蚓部下份活检导致蚓垂破坏后，出现了阵发性交替性斜视偏差和方向改变的眼球震颤。发作间期，她存在右眼高于左眼的斜视偏差以及无症状的右眼跳动性水平眼球震颤。静息性眼球震颤的慢相显示速度增加，类似于先天性眼球震颤。每隔40 - 50秒，她的斜视偏差会出现阵发性反转，伴有持续10 - 12秒的剧烈左眼跳动性水平扭转性眼球震颤，并导致严重的视振荡。有人提出，这种复杂的阵发性眼球运动障碍是由以下原因导致的：(1) 左侧前庭核的病变导致右眼高于左眼的斜视偏差和右眼跳动性静息性眼球震颤；(2) 小脑对前庭核的抑制作用中断，导致前庭系统的交替活动，伴有斜视偏差的间歇性反转和向病变侧的阵发性眼球震颤。
