Neuro-Otological Findings of Cerebellar Midline Tumors

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  • 小脳正中部腫瘍例の神経耳科学的考察
  • ショウノウ セイチュウブ シュヨウレイ ノ シンケイ ジカガクテキ コウサツ

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Abstract

Two cases of the localized metastatic carcinoma to the midline cerebellar structure were studied neuro-otologically.<br>The first was a fifty-seven year old woman, whose chief complaint was a feeling of unsteadiness.<br>Computed tomography showed a localized midline cerebellar tumor and this tumor was extirpated.<br>Neurological examinations revealed truncal ataxia, but no other cerebellar sign.<br>Neuro-otological examinations revealed the lack of a nystagmus, smooth pursuit eye movement, normal caloric response and normal optokinetic nystagmus.<br>Vertical downbeat nystagmus was demonstrated by the positioning nystagmus test from sitting to head down position.<br>The second patient was a fifty-three year old woman who complained of an unsteady gait.<br>Neurological examinations revealed a disturbance in tandem gait and left finger to nose test.<br>A cerebellar tumor slightly shifted to the left was demonstrated by computed tomography.<br>Lateral gaze nystagmus predominantly beating to the left was evident.<br>Pursuit eye movement and optokinetic nystagmus was slightly disturbed.<br>Suboccipital craniotomy was performed and the tumor was found to extend into the fourth ventricle from the cerebellar vermis.<br>The lesion in the second patient as seen at surgery was not only in the cerebellum itself but in the brain stem.<br>These two localized cerebellar midline tumors revealed the following:<br>1) Lateral gaze nystagmus was not demonstrated in a pure cerebellar midline lesion.<br>2) Smooth pursuit eye movement and optokinetic nystagmus was also normal.<br>3) The most striking finding neuro-otologically was vertical downbeat nystagmus seen on the positioning nystagmus test.

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