Res Vestib Sci.  2017 Dec;16(4):142-146. 10.21790/rvs.2017.16.4.142.

Gaze-Evoked and Perverted Head-Shaking Nystagmus in a Patient with Polycythemia Vera

  • 1Departement of Neurology, Chungnam National University Hospital, Daejeon, Korea.
  • 2Department of Neurology, Ulleung-Gun Health Center and Country Hospital, Ulleung, Korea.
  • 3Division of Hematology/Oncolgy, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.


Polycythemia vera (PV) is well known chronic myeloproliferative neoplasm, caused by clonal expansion of an abnormal hematopoietic stem cell. Patients with PV may present diverse neurologic symptoms including headache, dizziness or vertigo, tinnitus. However, the attention has not been directed to the neurootological findings in patients with PV. Here, we present a 71-year-old male patient with PV suffered from vertigo and headache. He demonstrated gaze-evoked nystagmus and perverted head shaking nystagmus. Transcranial Doppler showed decrement of blood flow velocity in posterior circulation. The patient's neuro-otologic findings were normalized as polychethemia and blood flow improved with repetitive phlebotomy and medications such as hydroxyurea and aspirin. Considering the neurological and hemodynamic findings in our patient, the mechanism of vertigo in PV could be explained by central vestibulopathy because of vascular insufficiency rather than peripheral vestibulopathy because of inner ear blood hyperviscosity.


Nystagmus; Vertigo; Polycythemia vera; Transcranial Doppler
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