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Case Reports
. 2022 Oct;12(5):e129-e132.
doi: 10.1212/CPJ.0000000000001138.

Downbeat Nystagmus Is Abolished by Alcohol in Nonalcoholic Wernicke Encephalopathy

Christoph Helmchen  1 , Björn Machner  1 , Janina von der Gablentz  1 , Andreas Sprenger  1 , David S Zee  1
Affiliations
Case Reports

Downbeat Nystagmus Is Abolished by Alcohol in Nonalcoholic Wernicke Encephalopathy

Christoph Helmchen et al. Neurol Clin Pract. 2022 Oct.

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.

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Figures

Figure 1
Figure 1. Modulation of DBN by Alcohol
Vertical (green) and horizontal (blue) eye position traces on leftward gaze before (upper row) and after (lower row) alcohol consumption (target = dashed line). Although DBN is markedly reduced by alcohol, it induces a small horizontal gaze-evoked nystagmus. DBN = downbeat nystagmus.
Figure 2
Figure 2. Box Plots of Slow Phase Velocities (°/s) of DBN
Various vertical (upper left) and horizontal (upper right) gaze positions before (upper row) and after alcohol consumption (lower row); median (red bar) with upper and lower quartiles, whiskers = range to most extreme data points, outliers = “+”. DBN = downbeat nystagmus.
See this image and copyright information in PMC

References

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