Persistent geotropic or apogeotropic nystagmus: recurrence and association with vestibular migraine

The underlying etiologies responsible for persistent geotropic nystagmus (PGN) and apogeotropic nystagmus (PAGN) remain elusive. In this study, we analyzed the symptoms of patients with PGN and PAGN and categorize them based on diagnostic criteria for established vestibular disorders.

Clinical signs, recurrences, and duration of vestibular symptoms in patients with PGN or PAGN were collated and included auditory, neurologic, and migrainous symptoms as well as migraine history. Patients were then reclassified into unique etiological groups according to the established diagnostic criteria for vestibular disorders.

Among 428 patients with nystagmus, 57 (13.3%) presented with PGN or PAGN. Of the 56 patients included in the study, 50 (89.3%) experienced a recurrence of vertigo or dizziness, and 28 (50%) had more than five episodes. Regarding the duration of symptoms, 32 patients (57.1%) experienced vestibular episodes lasting ≤ 1 day, and 46 patients (82.1%) had episodes lasting ≤ 1 week. Based on the available and accepted diagnostic categorization, 17 patients (30.4%) were diagnosed with vestibular migraine, 15 (26.8%) with probable vestibular migraine, 15 (26.8%) with benign recurrent vertigo, 3 (5.4%) with cerebellar lesions, 1 (1.8%) with sudden sensorineural hearing loss, and 5 (8.9%) with undetermined diagnoses.

While PGN and PAGN can be caused by various vestibular disorders, our data support the majority of cases are episodic and linked to the pathophysiology of vestibular migraine.