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Updated: May 18, 2026

A Standardized Pipeline for Examining Human Cerebellar Grey Matter Morphometry using Structural Magnetic Resonance Imaging
Published on: February 4, 2022
Alternating skew deviation due to hemorrhage in the cerebellar vermis
Hiromasa Tsuda1, Makoto Nagamata, Kozue Tanaka
1Department of Neurology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan. hiromasatsuda@cick.jp
Abstract:
A 76-year-old Japanese woman with essential hypertension and diabetes mellitus abruptly presented with nausea, dizziness, an occipital headache, truncal ataxia, gaze-evoked nystagmus and alternating skew deviation (ASD) with abducting eye hypertropia. Cranial computed tomography demonstrated hemorrhage in the cerebellar vermis and its vicinity. These symptoms gradually resolved within three weeks. This is the first reported case of ASD secondary to cerebellar hemorrhage without hydrocephalus. The vertical misalignment of the eyes during the right-sided gaze was consistently larger than during the left-sided gaze. We speculated that bilateral and asymmetrical damage to the utricular pathway due to the bilateral involvement of the nodulus and uvula might have caused the ASD.
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