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Abstract
Background and Objectives Lesions of the cerebellar flocculus cause enduring downbeat nystagmus (DBN) with unrelenting oscillopsia. Unlike most patients with DBN, the flocculus is structurally spared in nonalcoholic Wernicke encephalopathy (nWE) with chronic DBN. The objective was to study the effects of alcohol in nWE.
Methods We recorded eye movements of a unique patient with nWE under controlled alcohol consumption who said his oscillopsia disappeared with a few drinks of alcohol.
Results His DBN was markedly diminished by alcohol (by 77.4%), although he remained alert with normal saccades.
Discussion This striking observation may be caused by the differential effect of alcohol on the perihypoglossal complex and the paramedian tract neurons, which control the level of activity in the flocculus, with opposite (inhibition and excitation, respectively) effects. The finding suggests new ideas about the treatment and pathophysiology of DBN with a structurally intact cerebellum.
Footnotes
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.
↵* The authors contributed equally as co-senior authors.
Submitted and externally peer reviewed. The handling editor was Former Editor John R Corboy, MD, FAAN.
- Received June 28, 2021.
- Accepted September 20, 2021.
- © 2021 American Academy of Neurology
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