Syndrome of downbeat nystagm in two patients of different age

In ENT practice we often have to deal with patients with chronic or acute vertigo where central diseases need to be excluded. The syndrome of downbeat nystagm is symptom of a central vertigo. We talk about two cases of female patients with downbeat nystagm. A 15-year old girl (case 1) complained about daily intermitting vertigo for 1 year. A 82-year old woman (case 2) bemoaned permanent vertigo and instable walk for 3 months. ENT status as well as further diagnostics revealed no peripheral vestibular damage. Patient 1 showed no pathologic neurologic signs and an inconspicuous MRI scan. Patient 2 had an atactic walk and signs of artheriosclerotic disease in the pons region on MRI scan. After neurologic survey we began a therapy with 4-Aminopyridin combined with physiotherapeutic exercises in case 2. The younger patient got an appointment in a neurological clinic in January 2021.

The different presentations of vertigo as well as the varying findings on MRI-scan were eye-catching. An off label therapy with sodium canal blocker is positively discussed in literature, results remained open due to missed follow-up appointments. We hope to have further findings in case 2 after presentation in the neurologic clinic. Central vestibular diseases are important differential diagnoses in our subject. A good knowledge in neurologic examination is important to exclude rare central diseases from frequent peripheral vestibular maladies and guide patients to correct therapy as soon as possible.

Poster-PDF A-1575.pdf

Conflict of interest

Der Erstautor gibt keinen Interessenskonflikt an.

Publikationsverlauf

Artikel online veröffentlicht:
13. Mai 2021