Images in Neurology |

Lesion of the Nucleus Intercalatus in Primary Position Upbeat Nystagmus

Tsukasa Saito, MD; Hitoshi Aizawa, MD, PhD; Jun Sawada, MD, PhD; Takayuki Katayama, MD, PhD; Naoyuki Hasebe, MD, PhD
Arch Neurol. 2010;67(11):1403-1404. doi:10.1001/archneurol.2010.285.
Text Size: A A A
Published online


A 32-year-old woman was admitted to our hospital with dizziness lasting 2 weeks. On neurological examination, she showed primary position upbeat nystagmus (Figure 1; video). There were no other neurological abnormalities. T2-weighted magnetic resonance and fluid-attenuated inversion recovery imaging revealed multiple periventricular white matter lesions in the brain. A high-intensity spot was also present in the left side of posterior caudal medulla (Figure 1). We diagnosed her with multiple sclerosis and started 1 mg/d of methylprednisolone pulse therapy for 3 days. She gradually recovered, and the symptom disappeared in 2 weeks. The abnormal lesion in the medulla also became undetectable on magnetic resonance imaging.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.

The lesion, presenting on the left side of the dorsal caudal medulla. Part B is taken from Olszewski J, Baxter D. Cytoarchitecture of the Human Brain Stem. 2nd ed. Basel, NY: Karger; 1982.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Schematic diagram. Modified with permission from Brain.4

Graphic Jump Location




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics