Frontiers in Neurology (Feb 2023)

Spontaneous nystagmus with an upbeat component: Central or peripheral vestibular disorders?

  • Xia Ling,
  • Yue-Xia Wu,
  • Yu-Fei Feng,
  • Tong-Tong Zhao,
  • Gui-Ping Zhao,
  • Ji-Soo Kim,
  • Ji-Soo Kim,
  • Xu Yang,
  • Zhao-Xia Wang

DOI
https://doi.org/10.3389/fneur.2023.1106084
Journal volume & issue
Vol. 14

Abstract

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ObjectiveTo determine the topical diagnosis and etiologies of spontaneous nystagmus (SN) with an upbeat component.MethodsWe retrospectively recruited 43 patients with SN with an upbeat component at a university hospital in China from 2020 to 2022. SN with an upbeat component was divided into pure upbeat nystagmus (UBN), SN with a predominant upbeat component, and SN with a non-predominant upbeat component. We analyzed their clinical and neurotologic findings and the final diagnosis.ResultsFourteen (32.6%) of them showed pure UBN, while 29 (67.4%) exhibited SN mixed with an upbeat component, mixed upbeat-horizontal in 15, mixed upbeat-horizontal-torsional in 13, and upbeat-torsional in the remaining one. Pure UBN and SN with a predominant upbeat component were more common in central than in peripheral vestibular disorders [16 (80.0%) vs. 0 (0%), Chi-Square test, p < 0.001]. Central vestibular disorders were diagnosed in 20 (46.5%) patients, peripheral in 14 (32.6%), and undetermined in nine (20.9%) patients. The underlying causes mainly included acute unilateral peripheral vestibulopathy (n = 11), posterior circulation infarction (n = 9), benign recurrent vertigo (n = 4), vestibular migraine (VM, n = 3), and VM of childhood (n = 2).ConclusionSN with an upbeat component can be seen in both central and peripheral vestibular disorders. Pure UBN was a characteristic sign of central vestibular dysfunction. Central vestibular disorders should be highly suspected when patients show pure UBN or SN with a predominant upbeat component.

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