Dissociated Nystagmus as a Common Sign of Ocular Motor Disorders in HIV-infected Patients

Abstract

In order to determine if ocular motor disturbances due to brainstem and cerebellar dysfunction provide a frequent and early marker for HIV infection of the brain, neurological examination was performed in 133 HIV-infected persons who were consecutively admitted to our hospital. In 22 patients (17%) we found no other reason for cerebellar or pontomesencephalic signs than HIV encephalopathy. Ocular motor disorders accounted for the most frequent signs of cerebellar and pontomesencephalic dysfunction. Ocular motor disorders mainly consisted of dissociated nystagmus (n = 12), gaze-evoked nystagmus (n = 10) and impaired smooth pursuit (n = 6). Cerebellar ataxic gait and dysmetria were present in 3 patients. Since dissociated nystagmus was the primary ocular motor disorder, we assume that the medial longitudinal fasciculus may be a predilected circumscribed area for HIV infection of the brain. We suppose that cerebellar and pontomesencephalic disorders may be an early marker for HIV encephalopathy because they were the only neurological signs found in 12 patients.

Optokinetic Analysis in Patients With Spontaneous Horizontal Gaze-Evoked Nystagmus Without Radiological Neuropathology

“…[16][17][18] Patients with head trauma, cerebellar tumors, cranial surgery, and viral infections may also exhibit gaze-evoked nystagmus. 19,20 Five patients had migraine, 2 patients had a story of trauma, and 1 patient was using antidepressant drug in our series.…”

A rare case of HIV encephalopathy presenting with an isolated cerebellar syndrome

“…8 Additionally, ocular motor disorders can highlight early HIV encephalopathy in the form of cerebellar involvement. 14 Importantly, damage to the cerebellum may not be reversible, unless early treatment using ART with good CNS penetration are initiated. 8 However, it is prudent to note that there are conflicting data regarding the overall CNS benefits of individual antiretrovirals.…”

Atypical periodic alternating nystagmus responding to high-dose intravenous immunoglobulins: a case report

“…A few decades ago, oculomotor disturbances were found to account for the most prevalent sign of cerebellar and brainstem dysfunction in a large series of HIV-positive patients [6] and abnormal eye movements were present in 93% of HIV-infected patients with neurological signs [7]. Various nystagmus including central paroxysmal positional nystagmus [8] have been reported in HIV-positive individuals, but no case of PAN associated with HIV has been described previously.…”