Saccadic lateropulsion and upbeat nystagmus: Disorders of caudal medulla

@article{Tilikete2002SaccadicLA,
  title={Saccadic lateropulsion and upbeat nystagmus: Disorders of caudal medulla},
  author={Caroline Tilikete and Marc Hermier and Denis P{\'e}lisson and A. Vighetto},
  journal={Annals of Neurology},
  year={2002},
  volume={52}
}
Key ResultA patient developed a primary position upbeat nystagmus and a left saccadic lateropulsion. Magnetic resonance imaging demonstrated a probable cavernoma at right caudal paramedian medullary level. Anatomical correlations are discussed. Saccadic lateropulsion is attributed to olivocerebellar pathway impairment but usually is described in more rostral medullar lesions. Our case would still support this hypothesis because the lesion could have involved the olivocerebellar pathway at its very caudal…
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The finding that greater amplitude of horizontal contrapulsion on upward vs. downward vertical saccades in a patient with saccadic contrapulsive as a result of a focal demyelinating lesion of the left dorsolateral medulla suggests that such asymmetry is also present in humans and provides insight into the pathophysiology of saccade generation.
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The pathophysiology of spontaneous upbeat (UBN) and downbeat (DBN) nystagmus is reviewed in the light of several instructive clinical findings and experimental data and it is hypothesized that the excitatory SVN‐VTT pathway, along with its specific floccular inhibition, has developed to counteract the gravity pull.
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TLDR
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Nystagmus and saccadic intrusions.
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