Himi T, Kataura A, Tokuda S, Sumi Y, Kamiyama K, Shitamichi M
Department of Otolaryngology, Sapporo Medical College, Japan.
Am J Otol. 1995 May;16(3):377-81.
A case is reported of downbeat nystagmus associated with compression of the caudal brain stem by the dolichoectatic vertebral arteries, which was revealed by magnetic resonance imaging. Before surgery, the patient complained of oscillopsia at rest. Downbeat nystagmus was observed in the primary eye position and was increased in lateral gaze, especially to the left. Surgical repositioning of the left vertebral artery succeeded in resolving the downbeat nystagmus in the primary position within 1 month, and the nystagmus in all the other gaze positions almost completely disappeared over the subsequent months. Other ocular abnormalities also were improved after surgery. Thus, this case shows clear evidence of downbeat nystagmus arising from compression of dolichoectatic vertebral arteries to the medulla oblongata. Surgical neurovascular decompression of the dolichoectasia reverses the progression of symptoms if permanent neurologic damage has not already occurred.
报告了一例与扩张的椎动脉压迫脑干尾部相关的下跳性眼球震颤病例，磁共振成像显示了这一情况。手术前，患者主诉静息时视振荡。在第一眼位观察到下跳性眼球震颤，向侧方注视时加重，尤其是向左注视时。对左侧椎动脉进行手术重新定位成功在1个月内消除了第一眼位的下跳性眼球震颤，在随后几个月里，其他注视位的眼球震颤几乎完全消失。手术后其他眼部异常也得到改善。因此，该病例明确证明了下跳性眼球震颤由扩张的椎动脉压迫延髓引起。如果尚未发生永久性神经损伤，对椎动脉扩张进行手术神经血管减压可逆转症状进展。
