Reversible downbeat nystagmus secondary to excessive alcohol intake

Three patients are reported who presented with primary position downbeat nystagmus without any other evidence of cerebellar dysfunction. After 2 weeks of abstinence from alcohol, the downbeat nystagmus resolved totally in two cases, and could be elicited only with head hanging in the third. Radiologic evaluation, including computed tomographic (CT) scan of the posterior fossa and craniocervical junction, were normal in each case. These are the first cases reported of reversible downbeat nystagmus secondary to alcohol intake. They suggest that a patient with downbeat nystagmus and a history of recent significant alcohol intoxication should be observed for resolution of this sign after a period of abstinence before extensive radiologic evaluation is undertaken.