ReviewNeurology2018
Conversion of upbeat to downbeat nystagmus in Wernicke encephalopathy.
Review in Neurology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed, 39 citations in OpenAlex.
- Astrocytopathy in Wernicke Encephalopathy and Neuromyelitis Optica Spectrum Disorder. Pathogenic Differences With Occasional Clinical and Neuroimaging Overlap. A Review.Current neurology and neuroscience reports · 2026Review
- Alternating vertical nystagmus associated with Wernicke encephalopathy.Journal of neurology · 2025Article
- Usefulness of Nystagmus Patterns in Distinguishing Peripheral From Central Acute Vestibular Syndromes at the Bedside: A Critical Review.Journal of clinical neurology (Seoul, Korea) · 2025Review
- Fixational upbeat nystagmus: report of two cases and literature review.Journal of neurology · 2025Article
- Upbeat nystagmus: a clinical and pathophysiological review.Frontiers in neurology · 2025Review
- Generalized vestibular hyporeflexia and chronic upbeat nystagmus due to thiamine deficiency.Journal of neurology · 2023Article
- Two-muscle surgical treatment of a compensatory head tilt in an adult with acquired downbeat nystagmus.Proceedings (Baylor University. Medical Center) · 2023Article
- Spontaneous nystagmus with an upbeat component: Central or peripheral vestibular disorders?Frontiers in neurology · 2023Article
- Downbeat Nystagmus Is Abolished by Alcohol in Nonalcoholic Wernicke Encephalopathy.Neurology. Clinical practice · 2022Article
- Case report: Acute vestibular syndrome and cerebellitis in anti-Yo paraneoplastic syndrome.Frontiers in neurology · 2022Article
- Update on Nystagmus and Other Ocular Oscillations.Journal of clinical neurology (Seoul, Korea) · 2021Review
- Primary Position Upbeat Nystagmus with Low Serum Vitamin B12.Internal medicine (Tokyo, Japan) · 2020Article
- The Use of Video-Head Impulse Test in Different Head Positions in Vertical Nystagmus and Ataxia Associated with Probable Thiamine Deficiency.Cerebellum (London, England) · 2020Article
- Consensus Paper. Cerebellar Reserve: From Cerebellar Physiology to Cerebellar Disorders.Cerebellum (London, England) · 2020Review
- Nystagmus characteristics of healthy controls.Journal of vestibular research : equilibrium & orientation · 2020Article
- Neuro-ophthalmic Manifestations of Wernicke Encephalopathy.Eye and brain · 2020Review
- Vertical nystagmus in Wernicke's encephalopathy: pathogenesis and role of central processing of information from the otoliths.Journal of neurology · 2019Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo explain (1) why an initial upbeat nystagmus (UBN) converts to a permanent downbeat nystagmus (DBN) in Wernicke encephalopathy (WE) and (2) why convergence and certain vestibular provocative maneuvers may transiently switch UBN to DBN.
methodsFollowing a literature review and study of our 2 patients, we develop hypotheses for the unusual patterns of vertical nystagmus in WE.
resultsOur overarching hypothesis is that there is a selective vulnerability and a selective recovery from thiamine deficiency of neurons within brainstem gaze-holding networks. Furthermore, since the circuits affected in WE are commonly paraventricular, especially medially, just under the floor of the fourth ventricle where lie structures important for control of vertical gaze, we suggest the patterns of involvement in WE also reflect a breakdown in vulnerable areas of the blood-brain barrier. Many of the initial deficits of our patients improved over time, but their DBN did not. Irreversible changes in paramedian tract neurons, which project to the cerebellar flocculus, may be the cause. Here we suggest that conversion of UBN to permanent DBN points to thiamine deficiency and may argue for a chronic, nonprogressive DBN/truncal ataxia syndrome. Finally, we posit that the transient switch of UBN to DBN reflects abnormal processing of otolith information about linear acceleration, and often points to a diagnosis of WE.
conclusionRecognizing the unusual patterns of transient switching and then permanent conversion of UBN to DBN in WE is vital since long-term disability from WE may be prevented by timely, parenteral high-dose thiamine.
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