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October 22, 2021Case

Downbeat Nystagmus Is Abolished by Alcohol in Nonalcoholic Wernicke Encephalopathy

Christoph Helmchen, View ORCID ProfileBjoern Machner, Janina von der Gablentz, View ORCID ProfileAndreas Sprenger, View ORCID ProfileDavid S. Zee
First published October 22, 2021, DOI: https://doi.org/10.1212/CPJ.0000000000001138
Christoph Helmchen
1Department of Neurology, University Hospital Schleswig Holstein, Lübeck, Germany
2Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
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Bjoern Machner
1Department of Neurology, University Hospital Schleswig Holstein, Lübeck, Germany
2Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
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  • ORCID record for Bjoern Machner
Janina von der Gablentz
1Department of Neurology, University Hospital Schleswig Holstein, Lübeck, Germany
2Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
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Andreas Sprenger
1Department of Neurology, University Hospital Schleswig Holstein, Lübeck, Germany
3Institute of Psychology II, University Lübeck, Germany
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David S. Zee
4Departments of Neurology, Ophthalmology, Otolaryngology-Head and Neck Surgery, and Neuroscience, Division of Neuro-Visual and Vestibular Disorders, The Johns Hopkins Hospital, Baltimore, USA
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Citation
Downbeat Nystagmus Is Abolished by Alcohol in Nonalcoholic Wernicke Encephalopathy
Christoph Helmchen, Bjoern Machner, Janina von der Gablentz, Andreas Sprenger, David S. Zee
Neurol Clin Pract Oct 2021, 10.1212/CPJ.0000000000001138; DOI: 10.1212/CPJ.0000000000001138

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ABSTRACT

Objective: Lesions of the cerebellar flocculus cause enduring downbeat nystagmus (DBN) with unrelenting oscillopsia. Unlike most DBN patients, the flocculus is structurally spared in non-alcoholic Wernicke’s 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 alcohol.

Results: His downbeat nystagmus was markedly diminished by alcohol (by 77.4%) though he remained alert with normal saccades.

Conclusion: 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.

  • Received June 28, 2021.
  • Accepted September 20, 2021.
  • © 2021 American Academy of Neurology

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