Vertical nystagmus occurring after treatment of tonsillar cancer : A case report.

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A 49-year-old man developed vertical nystagmus after treatment of tonsillar cancer.He entered our hospital in January, 1981, and was treated with irradiation and anticancer therapy. The tonsillar cancer disappeared clinically, and he was discharged in April, 1981. The clinical course after treatment was favorable until July, 1981, when he suddenly developed dizziness, lack of balance, ataxia and upbeat nystagmus. He was readmitted to our hospital, where roentgenogram, electroencephalogram (EEG) and brain scan were all normal. After two months of drug therapy for vertigo his symptoms subsided, but upbeat nystagmus continued until December, 1981. Starting in January, 1982, he was treated with 5 Fluorouracil (5-Fu) to prevent the recurrence of cancer.Towards the middle of April, 1982, he complained of weakness, vertigo, anxiety, paralyzed limbs and downbeat nystagmus in all dirctions of gaze.The possible lesion in this case was located in the brainstem, the medulla oblongata and the cerebellum.Because of a past history of stimulant abuse (amphetamine) for one year and the background of irradiation and 5-Fu therapy, the cause of vertical nystagmus was thought to be a combination of: 1) tonic imbalance of the vertical pursuit system due to fragility of the reticular formation in the brainstem caused by amphetamine, 2) a circulatory disorder of the region under the vertebro basilar artery due to irradiation and 3) medullocerebellar lesions as toxic effects of 5-Fu.
耳鼻咽喉科臨床学会の論文

Vertical nystagmus occurring after treatment of tonsillar cancer : A case report.

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