Impaired Tilt Suppression of Post-Rotatory Nystagmus and Cross-Coupled Head-Shaking Nystagmus in Cerebellar Lesions: Image Mapping Study

Sun Uk Lee, Jeong Yoon Choi, Hyo Jung Kim, Jeong Jin Park, David S. Zee, Ji Soo Kim

Research output: Contribution to journalArticle


We sought to determine the cerebellar structures responsible for tilt suppression of post-rotatory nystagmus. We investigated ocular motor findings and MRI lesions in 73 patients with isolated cerebellar lesions who underwent recording of the vestibulo-ocular reflex (VOR) using rotatory chair tests. Tilt suppression of post-rotatory nystagmus was diminished in 27 patients (27/73, 37.0 %). The gains of the VOR and the TCs of per- and post-rotatory nystagmus did not differ between the patients with diminished and with normal tilt suppression. The patients with impaired tilt suppression showed perverted (“cross-coupled”) head-shaking nystagmus (pHSN) and central positional nystagmus (CPN) more frequently than those with normal responses. Tilt suppression was impaired in five (71.4 %) of the seven patients with isolated nodulus and uvular infarction. Probabilistic lesion-mapping analysis showed that the nodulus and uvula are responsible for tilt suppression. Impaired tilt suppression may be ascribed to disruption of cerebellar contribution to the vestibular velocity-storage mechanism, which integrates information from the semicircular canals and otolith organs to help derive the brain’s estimate of the head orientation relative to the pull of gravity.

Original languageEnglish (US)
Pages (from-to)95-102
Number of pages8
Issue number1
StatePublished - Feb 1 2017



  • Nodulus
  • Nystagmus
  • Uvula
  • Vertigo
  • Vestibulo-ocular reflex

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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