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We report on a patient who developed primary position upbeat nystagmus (ppUBN)due to a unilateral medial medullary infarction.On oculography,the slow phases of the nystagmus sometimes had an exponentially decreasing velocity waveform,indicating that the nystagmus was due to impairment of the vertical position-to-velocity neural integrator.On magnetic resonance imaging,the lesion was caudal to the vestibular nuclei and to the most rostral of the perihypoglossal nuclei,the nucleus intercalatus,a structure that was also involved in a previously reported case of ppUBN due to a unilateral medullary lesion.On the basis of these imaging and oculographic observations,we propose that a unilateral lesion of the nucleus intercalatus is sufficient to cause ppUBN and that the nucleus intercalatus is a part of the vertical position-to-velocity neural integrator in the human ocular-motor system. |
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brainstem,infarction of
cerebrovascular accident
medial medullary syndrome
medulla oblongata,infarction of
medulla oblongata,lesion of
MRI
MRI,abnormal
nystagmus
nystagmus,primary position of gaze
nystagmus,upbeating-in primary position of gaze
nystagmus,vertical
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