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Isolated nodular infarction

Cited 71 time in Web of Science Cited 81 time in Scopus
Authors
Moon, In Soo; Kim, Ji Soo; Choi, Kwang Dong; Kim, Min-Jeong; Oh, Sun-Young; Lee, Hyung; Lee, Hak-Seung; Park, Seong-Ho
Issue Date
2008-12-26
Publisher
American Heart Association
Citation
Stroke. 2009;40(2):487-491
Keywords
AdultAgedBrain Ischemia/pathologyCaloric TestsCerebellum/*pathologyCerebral AngiographyCerebral Infarction/*pathologyFemaleHumansMagnetic Resonance AngiographyMagnetic Resonance ImagingMaleMiddle AgedNeurologic ExaminationNystagmus, Pathologic/etiology/pathologyPostural Balance/physiologyReflex, Vestibulo-Ocular/physiologySensation Disorders/physiopathologyVertigo/etiologyVestibular Function TestsYoung Adult
Abstract
BACKGROUND AND PURPOSE: Isolated nodular infarction has rarely been described in human. The purpose of this study is to report clinical and laboratory findings of isolated nodular infarction. METHODS: Eight patients with isolated nodular infarction were recruited from 6 hospitals in Korea. All patients underwent a complete and standardized neurotological evaluation including ocular torsion, bithermal caloric tests, and rotatory chair test in addition to MRI and MR angiography. RESULTS: All patients presented with isolated vertigo and moderate to severe imbalance. The most common manifestation was unilateral nystagmus and falling in the opposite direction, which mimicked peripheral vestibulopathy. Six patients had unilateral lesion, and 2 showed bilateral lesions. The direction of the spontaneous nystagmus was all ipsilesional in the unilateral lesion. However, head impulse and bithermal caloric tests were normal. Other findings include periodic alternating nystagmus, perverted head shaking nystagmus, paroxysmal positional nystagmus, and impaired tilt suppression of the postrotatory nystagmus. Hypoplasia of the ipsilesional vertebral artery was the only abnormal finding on MR angiography in 3 patients. The prognosis was excellent. CONCLUSIONS: Isolated nodular infarction mostly presents with isolated vertigo mimicking acute peripheral vestibulopathy. However, severe imbalance and a negative head impulse test are important clinical discriminants between nodular infarcts and peripheral vestibular dysfunction. The findings of isolated nodular infarctions are consistent with impaired gravito-inertial processing of the vestibular signals and disrupted nodular inhibition on the vestibular secondary neurons and the velocity storage mechanism.
ISSN
1524-4628 (Electronic)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19109545

http://stroke.ahajournals.org/cgi/reprint/40/2/487.pdf

http://hdl.handle.net/10371/68019
DOI
https://doi.org/10.1161/STROKEAHA.108.527762
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Neurology (신경과학교실)Journal Papers (저널논문_신경과학교실)
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