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mentum, which resulted in right facial palsy and left hemiparesis, and one-and-a-half syndrome. Eighty days after a stroke, he manifested progressively blurred vision and oscillopsia, corresponding to a vertical pendular nystagmus. Additionally, the abnormal rhythmic involuntary movements of his left upper extremity (brachial myoclonus) appeared simultaneously. In addition to the disturbances of the horizontal eye movements, the vertical gaze was also disturbed. The patient also complained of photophobia and often tried to close his eyes. Although his hearing acuities were within the normal range (right ear 28.8 dB, left ear 25.0 dB), he always complained of hearing disturbance of his right ear which might suggest the involvements of the central auditory pathways at the pontine lesion. T 1weighted MRI findings showed a hemosiderinand ferritinlined cleft confined to the right side of the dorsal pontine tegmentum and the central tegmental tract. Furthermore, T 2weighted or FLAIR MRI revealed the enlargement of the right inferior olivary nuclei with high intensity signals, which is the typical appearance of hypertrophic olivary degeneration (HOD). Electronystagmography (ENG) showed the acquired vertical pendular nystagmus was prominent with a frequency of 2.5 c/s and the amplitude of 5-7 degrees. Although the vertical eye movements were slightly recorded in the light, they could not be completely detected in the dark. However, the vertical “doll’s eye phenomenon” was identified in the vertical plane, suggesting supranuclear vertical gaze palsy, with the convergence being additionally preserved. In the eye tracking test (ETT), the pursuit was dysmetric intermingled with a catch-up saccade both horizontally and vertically. Optokinetic nystagmus (OKN) could hardly be induced in both the horizontal and vertical stimulation, though the fast phase of nystagmus to the left could be slightly induced. Furthermore, the ice water 原 著

equilibrium research

One-and-a-half syndrome followed by the acquired pendular vertical nystagmus, brachial myoclonus and olivary hypertrophy caused by a pontine hemorrhage