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Brain, Vol. 113, No. 5, 1425-1439, 1990
© 1990 Guarantors of Brain

research-article

VESTIBULAR FUNCTION IN PERIODIC ALTERNATING NYSTAGMUS

JOSEPH M. R. FURMAN1,, CONRAD WALL, III1,* and DACHLING PANG2

1Department of Otolaryngology Pittsburgh, USA 2Department of Neurosurgery, University of Pittsburgh Pittsburgh, USA

Correspondence to: Correspondence to: Dr Joseph M. R. Furman, Department of Otolaryngology, Suite 500, Eye and Ear Institute of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA 15213, USA.

The vestibulo-ocular reflex of 4 patients with periodic alternating nystagmus (PAN) was studied in detail. Rotational testing was used to investigate the horizontal semicircular canal-ocular reflex, canal-otolith interaction, and the dynamic otolith-ocular reflex. Results indicated abnormal gain and phase of the horizontal semicircular canal-ocular reflex during sinusoidal rotation and a variable rate of decay of postrotatory responses. Each patient had abnormal canal-otolith interaction. An enlarged modulation component of the dynamic otolith-ocular response was observed in each patient. This study supports the idea that PAN is caused by an instability in the velocity storage element, a hypothetical neural circuit that perseverates the eye movement response to both vestibular and optokinetic stimulation. Further, we postulate that PAN may be caused by lesions of the cerebellar uvula and nodulus or their connections with the brainstem vestibular nuclei.

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Received April 29, 1988. Revised November 3, 1989. Accepted November 21, 1989.

*Present address: Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles street, Boston, MA 02114, USA.


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