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

• Kim YS
• Song IC
• Jeong SH
• Lee AY
• Kim JM

• KMID: 2400992
• DOI: http://doi.org/10.21790/rvs.2017.16.4.142

Abstract

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.

Keyword

Nystagmus; Vertigo; Polycythemia vera; Transcranial Doppler

MeSH Terms

Aged
Aspirin
Blood Flow Velocity
Dizziness
Ear, Inner
Head
Headache
Hematopoietic Stem Cells
Hemodynamics
Humans
Hydroxyurea
Male
Neurologic Manifestations
Phlebotomy
Polycythemia Vera*
Polycythemia*
Tinnitus
Vertigo
Aspirin
Hydroxyurea