Head-shaking aids in the diagnosis of acute audiovestibular loss due to anterior inferior cerebellar artery infarction

Audiol Neurootol. 2013;18(2):114-24. doi: 10.1159/000345643. Epub 2012 Dec 28.


Objective: To determine the patterns and diagnostic value of head-shaking nystagmus (HSN) in patients with acute audiovestibular loss.

Method: Eighteen patients underwent evaluation of spontaneous nystagmus, gaze-evoked nystagmus, HSN, head impulse test, ocular tilt reaction, subjective visual vertical, bithermal caloric tests, and pure-tone audiogram. The findings were compared with those of 21 patients with labyrinthitis.

Results: Fifteen patients (83%) exhibited HSN, and the horizontal HSN usually beat contralesionally (10/14, 71%). However, 9 (50%) patients also showed patterns of central HSN that included perverted HSN (n=7), HSN in the opposite direction of spontaneous nystagmus (n=4), and HSN beating towards unilateral canal paresis or abnormal head impulse testing (n=3). Overall, central HSN, gaze-evoked nystagmus, and normal head impulse testing were specific for anterior inferior cerebellar artery (AICA) infarction. Moreover, central HSN was the only sign that indicated stroke in 1 of our patients with isolated audiovestibular syndrome. Lesion subtraction analyses revealed that damage to the flocculus was relatively frequent in patients with perverted HSN.

Conclusions: In AICA infarction, HSN was common with both peripheral and central patterns. Careful evaluation of HSN may provide clues for AICA infarction in patients with acute audiovestibular loss.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Cerebellum / blood supply
  • Cross-Sectional Studies
  • Diagnostic Techniques, Neurological*
  • Eye Movements / physiology
  • Female
  • Head Movements / physiology*
  • Humans
  • Infarction, Posterior Cerebral Artery / diagnosis*
  • Infarction, Posterior Cerebral Artery / physiopathology
  • Labyrinthitis / diagnosis
  • Labyrinthitis / physiopathology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Nystagmus, Pathologic / diagnosis*
  • Nystagmus, Pathologic / physiopathology
  • Otolithic Membrane / physiology
  • Stroke / diagnosis
  • Stroke / physiopathology
  • Vertigo / diagnosis*
  • Vertigo / physiopathology
  • Vestibular Diseases / diagnosis*
  • Vestibular Diseases / physiopathology