RT Journal Article
SR Electronic
T1 Downbeat Nystagmus Is Abolished by Alcohol in Nonalcoholic Wernicke Encephalopathy
JF Neurology: Clinical Practice
FD Lippincott Williams & Wilkins
SP e129
OP e132
DO 10.1212/CPJ.0000000000001138
VO 12
IS 5
A1 Helmchen, Christoph
A1 Machner, Björn
A1 Gablentz, Janina von der
A1 Sprenger, Andreas
A1 Zee, David S.
YR 2022
UL http://cp.neurology.org/content/12/5/e129.abstract
AB 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.