Case Report: 2 Cases with Arterial Lesions Presenting Positional Vertical Nystagmus

Abstract

Patients with low tone hearing impairment with repeated vertigo are often diagnosed and treated as Meniere's disease. We reported cases with arterial lesions presenting positional veritcal nystagmus. Case 1 was a 33-year-old woman treated as Meniere's disease because of bilateral low tone hearing impairments and repeating vertigo. She had dysphonia from childhood and a right central retinal artery occlusion. The level of anti-nucleus antibody was significantly elevated. It showed a relation to some autoimmuno vasculitis and vasculitis probably caused the low tone hearing impairment and vertigo. Case 2 was a 50-year-old women who had right deafness and repeated vertigo. However, upbeat nystagmus was presented. Delayed endolymphatic hydrops cannot explain the reason why vertical nystagmus was presented. MRI revealed multiple ischemic lesions for her age. It was related to microangiopathy and she probably suffered from incomplete Susac syndrome. Microangiopathy was probably the pathophysiology in both cases and somewhere occluded the neural pathway of vertical eye movement. It was thought that unsymmetrical stimulation of anterior and posterior semicircular canals decollated the semicircular canal reflex and caused vertical nystagmus.