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Vestibular and Ocular Motor Properties in Cerebellar Infarction

Published online by Cambridge University Press:  04 March 2025

Xia Ling Open the ORCID record for Xia Ling [Opens in a new window] ,
Liying Chang Open the ORCID record for Liying Chang [Opens in a new window] ,
Yufei Feng Open the ORCID record for Yufei Feng [Opens in a new window] ,
Yuexia Wu Open the ORCID record for Yuexia Wu [Opens in a new window] ,
Yuan Xu Open the ORCID record for Yuan Xu [Opens in a new window] ,
Jianrong Wang Open the ORCID record for Jianrong Wang [Opens in a new window] ,
Guiping Zhao Open the ORCID record for Guiping Zhao [Opens in a new window] ,
Ji-Soo Kim Open the ORCID record for Ji-Soo Kim [Opens in a new window] ,
Xu Yang Open the ORCID record for Xu Yang [Opens in a new window]  and
Zhaoxia Wang Open the ORCID record for Zhaoxia Wang [Opens in a new window]
Xia Ling
Affiliation:
Department of Neurology, Peking University First Hospital, Beijing, China
Liying Chang
Affiliation:
Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
Yufei Feng
Affiliation:
Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
Yuexia Wu
Affiliation:
Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
Yuan Xu
Affiliation:
Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
Jianrong Wang
Affiliation:
Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
Guiping Zhao
Affiliation:
Department of Neurology, Peking University First Hospital, Beijing, China
Ji-Soo Kim
Affiliation:
Dizziness Center, Seoul National University Bundang Hospital, Seongnam, South Korea Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
Xu Yang
Affiliation:
Department of Neurology, Peking University First Hospital, Beijing, China Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
Zhaoxia Wang*
Affiliation:
Department of Neurology, Peking University First Hospital, Beijing, China
*
Corresponding author: Zhaoxia Wang; Email: [email protected]
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Abstract

Background:

The study aimed to determine the patterns of the vestibular and ocular motor findings in cerebellar infarction (CI).

Methods:

We retrospectively analyzed vestibular and ocular motor test results in 23 CI patients and 32 acute unilateral vestibulopathy (AUVP) patients.

Results:

Among CI cases, the posterior inferior cerebellar artery (PICA) was the most commonly affected territory. Vertigo is predominantly observed in patients with infarctions affecting PICA or anterior inferior cerebellar artery (AICA). Lesions involving the superior cerebellar artery (SCA) mainly result in dizziness. Saccadic intrusion and oscillation, abnormal bilateral smooth pursuit (SP) and abnormal saccades were more prevalent in the CI group than in the AUVP group (all p < 0.05). Horizontal saccades were abnormal in 11 patients (47.8%) with CI. All AUVP patients had normal horizontal saccades. Horizontal SP was impaired in 13 patients (56.5%) with CI, with decreased gain toward both sides in 10 and toward 1 side in 3. Impaired horizontal SP was noted in nine patients (28.1%) with AUVP, with decreased gain toward the contralesional side in all cases. A total of 26.3% (5/19) of patients with CI exhibited subjective visual vertical (SVV) deviation toward the affected side and 31.6% (6/19) toward the unaffected side. In patients with AUVP, 70.0% (21/30) showed SVV deviation toward the affected side.

Conclusions:

Vertigo is mainly seen in PICA or AICA infarctions. SCA lesions mostly cause dizziness. Saccadic intrusion and oscillation, abnormal bilateral SP and abnormal saccades contribute to the diagnosis of CI. Moreover, SVV deviation varies depending on the cerebellar structures involved.

Résumé

RÉSUMÉ

Les propriétés motrices vestibulaires et oculaires dans l’infarctus du cervelet.

Contexte :

L’étude visait à déterminer les types de troubles moteurs vestibulaires et oculaires dans l’infarctus du cervelet (IC).

Méthode :

Il s’agit d’une étude rétrospective, portant sur les résultats d’examens moteurs vestibulaires et oculaires, obtenus chez 23 patients ayant subi un IC et chez 32 patients atteints d’une vestibulopathie unilatérale aiguë (VUA).

Résultats :

Dans les cas de l’IC, le territoire le plus souvent affecté était celui irrigué par l’artère cérébelleuse postéro-inférieure (ACPI). Les vertiges étaient la manifestation la plus fréquente, observée chez les patients ayant subi un infarctus de l’ACPI ou de l’artère cérébelleuse antéro-inférieure (ACAI). Les lésions de l’artère cérébelleuse supérieure (ACS) se traduisaient surtout par des étourdissements. Les intrusions et les oscillations saccadées, la poursuite oculaire continue (POC) bilatérale anormale et les saccades anormales étaient plus fréquentes dans le groupe de l’IC que dans celui de la VUA (tous sujets confondus : p < 0,05). Les saccades horizontales étaient anormales chez 11 patients (47,8 %) ayant subi un IC, mais elles étaient toutes normales chez les patients atteints d’une VUA. Treize patients (56,5 %) dans le groupe de l’IC présentaient une altération de la POC horizontale, accompagnée d’une diminution du gain dans les deux directions chez 10 patients et dans une direction chez 3 patients. Une POC horizontale anormale a été observée chez 9 patients (28,1 %) atteints d’une VUA, accompagnée d’une diminution du gain vers le côté controlésionel dans tous les cas. Par ailleurs, 26,3 % des patients (5/19) ayant subi un IC présentaient une déviation de la verticale visuelle subjective (VVS) vers le côté affecté, et 31,6 % (6/19), vers le côté sain. Enfin, 70,0 % (21/30) des patients souffrant d’une VUA montraient une déviation de la VVS vers le côté atteint.

Conclusion :

Les vertiges s’observent principalement dans les infarctus de l’ACPI ou de l’ACAI. Les lésions de l’ACS causent surtout des étourdissements. La présence d’intrusions et d’oscillations saccadées, d’une poursuite oculaire continue (POC) bilatérale anormale et de saccades anormales facilite la pose du diagnostic d’IC. Enfin, la déviation de la VVS varie selon l’atteinte des structures cérébelleuses.

Keywords

acute unilateral vestibulopathycerebellar infarctiondizzinessocular motor testvertigo
Type
Original Article
Information
Canadian Journal of Neurological Sciences , First View , pp. 1 - 9
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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Footnotes

Xia Ling and Liying Chang contributed equally to this article.

References

Lee, H. Neuro-otological aspects of cerebellar stroke syndrome. J Clin Neurol (Seoul, Korea). 2009;5(2):65–73.Google Scholar
Lee, SH, Kim, JS. Acute diagnosis and management of stroke presenting dizziness or vertigo. Neurol Clin. 2015;33(3):687–698.Google Scholar
Volgger, V, Gürkov, R. Acute vestibular syndrome in cerebellar stroke : a case report and review of the literature. Hno. 2017;65(Suppl 2):149–152.Google Scholar
Kattah, JC, Talkad, AV, Wang, DZ, Hsieh, YH, Newman-Toker, DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009;40(11):3504–3510.Google Scholar
Elhfnawy, AM, Abd El-Raouf, M, Volkmann, J, Fluri, F, Elsalamawy, D. Relation of infarction location and volume to vertigo in vertebrobasilar stroke. Brain Behav. 2020;10(3):e01564.Google Scholar
Lee, H, Sohn, SI, Cho, YW, et al. Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology. 2006;67(7):1178–1183.Google Scholar
Nelson, JA, Viirre, E. The clinical differentiation of cerebellar infarction from common vertigo syndromes. West J Emerg Med. 2009;10(4):273–277.Google Scholar
Ogawa, K, Suzuki, Y, Oishi, M, Kamei, S, Shigihara, S, Nomura, Y. Clinical study of medial area infarction in the region of posterior inferior cerebellar artery. J Stroke Cerebrovasc Dis Off J natl Stroke Assoc. 2013;22(4):508–513.Google Scholar
Amarenco, P, Rosengart, A, DeWitt, LD, Pessin, MS, Caplan, LR. Anterior inferior cerebellar artery territory infarcts. Mechanisms and clinical features. Arch Neurol. 1993;50(2):154–161.Google Scholar
Lee, H, Sohn, SI, Jung, DK, et al. Sudden deafness and anterior inferior cerebellar artery infarction. Stroke. 2002;33(12):2807–2812.Google Scholar
Lee, H, Kim, JS, Chung, EJ, et al. Infarction in the territory of anterior inferior cerebellar artery: spectrum of audiovestibular loss. Stroke. 2009;40(12):3745–3751.Google Scholar
Shemesh, AA, Zee, DS. Eye movement disorders and the cerebellum. J Clin Neurophysiol Off Publication Am Electroencephalogr Soc. 2019;36(6):405–414.Google Scholar
Bisdorff, A, Von Brevern, M, Lempert, T, Newman-Toker, DE. Classification of vestibular symptoms: towards an international classification of vestibular disorders. J Vestib Res Equilib Orientat. 2009;19(1-2):1–13.Google Scholar
Choi, JH, Kim, HW, Choi, KD, et al. Isolated vestibular syndrome in posterior circulation stroke: frequency and involved structures. Neurol Clin Pract. 2014;4(5):410–418.Google Scholar
Strupp, M, Bisdorff, A, Furman, J, et al. Acute unilateral vestibulopathy/vestibular neuritis: diagnostic criteria. J Vestib Res Equilib Orientat. 2022;32(5):389–406.Google Scholar
Huh, YE, Kim, JS. Patterns of spontaneous and head-shaking nystagmus in cerebellar infarction: imaging correlations. Brain. 2011;134(Pt 12):3662–3671.Google Scholar
Sakagami, M, Wada, Y, Shiozaki, T, Ota, I, Kitahara, T. Results of subjective visual vertical tests in patients with vertigo/dizziness. Auris Nasus Larynx. 2022;49(3):342–346.Google Scholar
Lee, SU, Kim, HJ, Lee, ES, Choi, JH, Choi, JY, Kim, JS. Central positional nystagmus in inferior cerebellar peduncle lesions: a case series. J Neurol. 2021;268(8):2851–2857.Google Scholar
Li, Z, Liu, B, Si, H, et al. Clinical characteristics of patients with dizziness/Vertigo accompanied by posterior semicircular canal hypofunction. Front Med. 2021;8:589969.Google Scholar
Williams, D, Wilson, TG. The diagnosis of the major and minor syndromes of basilar insufficiency. Brain. 1962;85:741–774.Google Scholar
Newman-Toker, DE, Hsieh, YH, Camargo, CA Jr., Pelletier, AJ, Butchy, GT, Edlow, JA. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc. 2008;83(7):765–775.Google Scholar
Kim, SH, Kim, HJ, Kim, JS. Isolated vestibular syndromes due to brainstem and cerebellar lesions. J Neurol. 2017;264(Suppl 1):63–69.Google Scholar
Wright, J, Huang, C, Strbian, D, Sundararajan, S. Diagnosis and management of acute cerebellar infarction. Stroke. 2014;45(4):e56–e58.Google Scholar
Miao, HL, Zhang, DY, Wang, T, Jiao, XT, Jiao, LQ. Clinical importance of the posterior inferior cerebellar artery: a review of the literature. Int J Med Sci. 2020;17(18):3005–3019.Google Scholar
Mehler, MF. The rostral basilar artery syndrome: diagnosis, etiology, prognosis. Neurology. 1989;39(1):9–16.Google Scholar
Kase, CS, Norrving, B, Levine, SR, et al. Cerebellar infarction. Clinical and anatomic observations in 66 cases. Stroke. 1993;24(1):76–83.Google Scholar
Perloff, MD, Patel, NS, Kase, CS, Oza, AU, Voetsch, B, Romero, JR. Cerebellar stroke presenting with isolated dizziness: brain MRI in 136 patients. Am J Emerg Med. 2017;35(11):1724–1729.Google Scholar
Fogwe, DT, Sandhu, DS, Goyal, A, Mesfin, FB. Neuroanatomy of the anterior inferior cerebellar arteries. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.Google Scholar
Li, X, Zhang, D, Zhao, J. Anterior inferior cerebellar artery aneurysms: six cases and a review of the literature. Neurosurg Rev. 2012;35(1):111–119. discussion 9.Google Scholar
Delion, M, Dinomais, M, Mercier, P. Arteries and veins of the cerebellum. Cerebellum (London, England). 2017;16(5-6):880–912.Google Scholar
Ogawa, K, Suzuki, Y, Takahashi, K, Akimoto, T, Kamei, S, Soma, M. Clinical study of seven patients with infarction in territories of the anterior inferior cerebellar artery. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2017;26(3):574–581.Google Scholar
Nam, HW, Yoo, D, Lee, SU, et al. Labyrinthine infarction mimicking vestibular neuritis. Neurology. 2021;97(16):787–790.Google Scholar
Kim, D-H. Isolated flocculus infarction mimicking acute labyrinthitis. J Korean Neurol Assoc. 2011;29(3):241–245.Google Scholar
Sarikaya, H, Steinlin, M. Chapter 20 - cerebellar stroke in adults and children. In: Manto, M, Huisman, TAGM, editors. Handbook of clinical neurology, Elsevier; 2018: 301–312.Google Scholar
Malicki, M, Szmyd, BM, Bobeff, EJ, et al. The superior cerebellar artery: variability and clinical significance. Biomedicines. 2023;11(7):2009.Google Scholar
Terao, S, Sobue, G, Izumi, M, Miura, N, Takeda, A, Mitsuma, T. Infarction of superior cerebellar artery presenting as cerebellar symptoms. Stroke. 1996;27(9):1679–1681.Google Scholar
Lee, H, Kim, HA. Nystagmus in SCA territory cerebellar infarction: pattern and a possible mechanism. J Neurol Neurosurg Psychiatry. 2013;84(4):446–451.Google Scholar
Herishanu, YO, Sharpe, JA. Normal square wave jerks. Invest Ophth Vis Sci. 1981;20(2):268–272.Google Scholar
Shallo-Hoffmann, J, Petersen, J, Mühlendyck, H. How normal are “normal” square wave jerks? Invest Ophth Vis Sci. 1989;30(5):1009–1011.Google Scholar
Leigh, RJ, Zee, DS. The neurology of eye movements. 5th edition. New York, NY: Oxford University Press; 2015.Google Scholar
Zachou, A, Armenis, G, Stamelos, I, Stratigakou-Polychronaki, E, Athanasopoulos, F, Anagnostou, E. Clinical utility of square-wave jerks in neurology and psychiatry. Front Ophthalmol. 2024;3:1302651.Google Scholar
Otero-Millan, J, Macknik, SL, Serra, A, Leigh, RJ, Martinez-Conde, S. Triggering mechanisms in microsaccade and saccade generation: a novel proposal. Ann N Y Acad Sci. 2011;1233:107–116.Google Scholar
Anagnostou, E, Karavasilis, E, Potiri, I, et al. A cortical substrate for square-wave jerks in progressive supranuclear palsy. J Clin Neurol (Seoul, Korea). 2020;16(1):37–45.Google Scholar
Choi, SY, Choi, YJ, Choi, JH, Choi, KD. Teaching video neuroImages: macrosaccadic oscillations induced by horizontal head impulses. Neurology. 2017;89(9):e116.Google Scholar
Baier, B, Dieterich, M. Incidence and anatomy of gaze-evoked nystagmus in patients with cerebellar lesions. Neurology. 2011;76(4):361–365.Google Scholar
Wu, YX, Ling, X, Zhao, TT, et al. Contraversive ocular tilt reaction, body lateropulsion and gaze-evoked nystagmus after inferior cerebellar peduncle and dentate nucleus stroke. J Neuroophthalmol Off J North Am Neuroophthalmol Soc. 2023;43(4):e322–e324.Google Scholar
Sharpe, JA. Neurophysiology and neuroanatomy of smooth pursuit: lesion studies. Brain Cognition. 2008;68(3):241–254.Google Scholar
Baier, B, Stoeter, P, Dieterich, M. Anatomical correlates of ocular motor deficits in cerebellar lesions. Brain. 2009;132(Pt 8):2114–2124.Google Scholar
Lee, SH, Park, SH, Kim, JS, Kim, HJ, Yunusov, F, Zee, DS. Isolated unilateral infarction of the cerebellar tonsil: ocular motor findings. Ann Neurol. 2014;75(3):429–434.Google Scholar
Macdonald, NK, Kaski, D, Saman, Y, Al-Shaikh Sulaiman, A, Anwer, A, Bamiou, DE. Central positional nystagmus: a systematic literature review. Front Neurol. 2017;8:141.Google Scholar
Choi, JY, Kim, JH, Kim, HJ, Glasauer, S, Kim, JS. Central paroxysmal positional nystagmus: characteristics and possible mechanisms. Neurology. 2015;84(22):2238–2246.Google Scholar
Ling, X, Kim, HJ, Lee, JH, Choi, JY, Yang, X, Kim, JS. Positioning velocity matters in central paroxysmal positional vertigo: implication for the mechanism. Front Neurol. 2020;11:591602.Google Scholar
Choi, JY, Glasauer, S, Kim, JH, Zee, DS, Kim, JS. Characteristics and mechanism of apogeotropic central positional nystagmus. Brain. 2018;141(3):762–775.Google Scholar
Feng, Y, Zhao, T, Wu, Y, et al. The diagnostic value of the ocular tilt reaction plus head tilt subjective visual vertical (± 45°) in patients with acute central vascular vertigo. Front Neurol. 2022;13:1022362.Google Scholar
Baier, B, Bense, S, Dieterich, M. Are signs of ocular tilt reaction in patients with cerebellar lesions mediated by the dentate nucleus? Brain. 2008;131(Pt 6):1445–1454.Google Scholar
Choi, SY, Lee, SH, Kim, HJ, Kim, JS. Impaired modulation of the otolithic function in acute unilateral cerebellar infarction. Cerebellum (London, England). 2014;13(3):362–371.Google Scholar
Newman-Toker, DE, Kerber, KA, Hsieh, YH, et al. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med Off J Soc Acad Emerg Med. 2013;20(10):986–996.Google Scholar
Jorns-Häderli, M, Straumann, D, Palla, A. Accuracy of the bedside head impulse test in detecting vestibular hypofunction. J Neurol Neurosurg Psychiatry. 2007;78(10):1113–1118.Google Scholar
Helmchen, C, Knauss, J, Trillenberg, P, Frendl, A, Sprenger, A. Role of the patient’s history of vestibular symptoms in the clinical evaluation of the bedside head-impulse test. Front Neurol. 2017;8:51.Google Scholar
Machner, B, Erber, K, Choi, JH, Trillenberg, P, Sprenger, A, Helmchen, C. Usability of the head impulse test in routine clinical practice in the emergency department to differentiate vestibular neuritis from stroke. Eur J Neurol. 2021;28(5):1737–1744.Google Scholar
Korda, A, Wimmer, W, Zamaro, E, et al. Videooculography “HINTS” in acute vestibular syndrome: a prospective study. Front Neurol. 2022;13:920357.Google Scholar