Review of 79 patients shows MRI and oculomotor assessment localize central stroke lesions.
Photo by Brett Jordan / Unsplash
Key Takeaway
Note that instrumental oculomotor assessment aids early localization of posterior circulation infarcts in patients with central nystagmus.
This case report and scoping literature review focuses on 79 patients presenting with spontaneous nystagmus of central origin. The scope covers the diagnostic utility of MRI and instrumental oculomotor assessment in the context of central stroke, acute vestibular syndrome, and pseudo-vestibular neuritis. The setting and specific funding or conflicts of interest were not reported.
Key synthesized findings indicate that every single one of the 79 patients had stroke or infarction found on MRI. The most frequent localization of lesions identified within this cohort was the cerebellum. The review does not report specific adverse events, discontinuations, or tolerability data for the interventions described.
The authors note that instrumental oculomotor assessment, in conjunction with advanced neuroimaging techniques, enables early and accurate localization of posterior circulation infarcts. This finding suggests a strong diagnostic correlation between the clinical presentation of spontaneous nystagmus and confirmed infarction in this specific cohort. However, the practice relevance is tempered by the observational nature of the source material, which limits broad causal inferences.
View Original Abstract ↓
IntroductionPosterior inferior cerebellar artery (PICA) strokes often present with acute vestibular symptoms that may mimic peripheral disorders, posing significant diagnostic challenges. Prompt recognition and targeted management are essential to prevent misdiagnosis and improve outcomes.Case descriptionA 55-year-old woman with acute isolated vertigo showed only a horizontal spontaneous nystagmus, and a diagnosis of stroke on MRI was obtained.MethodsMultiple databases (MEDLINE, EMBASE, Web of Science, Scopus, PubMed, and Cochrane) were searched, using a cutoff date of May 2025, to identify English-language studies on pseudo-vestibular neuritis, which mimic a peripheral disease. We reviewed 112 full-text articles and found 33 reporting data that met the inclusion criteria.ResultsWe found 79 patients that presented at diagnosis with a spontaneous nystagmus of central origin. Every patient was submitted to MRI and a stroke or infarction was found. The most frequent localization of the lesions was the cerebellum.DiscussionInstrumental oculomotor assessment, in conjunction with advanced neuroimaging techniques, enables early and accurate localization of posterior circulation infarcts.
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