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Neurological rarities
Pulse-synchronous torsional nystagmus
  1. Ivan Milenkovic1,
  2. Thomas Sycha1,
  3. Evelyn Berger-Sieczkowski1,
  4. Paulus Rommer1,
  5. Christian Czerny2,
  6. Gerald Wiest1
  1. 1 Department of Neurology, Medical University of Vienna, Wien, Austria
  2. 2 Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Wien, Austria
  1. Correspondence to Professor Gerald Wiest, Department of Neurology, Medical University of Vienna, Wien 1090, Austria; gerald.wiest{at}meduniwien.ac.at

Abstract

Purely torsional spontaneous nystagmus almost always has a central vestibular cause. We describe a man with spontaneous pulse-synchronous torsional nystagmus in which the clockwise component corresponded to his pulse upswing, in keeping with a peripheral vestibular cause; following imaging we diagnosed left-sided superior canal dehiscence syndrome. Identifying pulse synchronicity of spontaneous nystagmus may help to distinguish central from peripheral vestibular torsional nystagmus, and is readily confirmed at the bedside using Frenzel’s glasses and a pulse oximeter.

  • neurootology
  • neuroophthalmology
  • eye movements
  • clinical neurology

https://doi.org/10.1136/practneurol-2021-003027

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    Footnotes

    • Contributors IM: patient care, paper concept, design and drafting, interpretation of data; TS: data acquisition, critical revision of manuscript for intellectual content; EB-S, PR: patient care, critical revision of manuscript for intellectual content; CC: data acquisition (imaging), paper design and critical revision of manuscript for intellectual content; GW: patient care, paper concept and design, critical revision of manuscript for intellectual content, supervision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned. Externally peer reviewed by Diego Kaski, London, UK.

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