Apogeotrophic type of direction-changing positional nystagmus related to slow vertebrobasilar blood flow

We examined the incidence of slow blood flow (SBF) in the vertebrobasilar system by magnetic resonance imaging (MRI) in 35 patients showing direction-changing positional nystagmus (DCPN). The subjects consisted of 20 patients with apogeotrophic type (group A) and 15 with geotrophic type (group B) of DCPN. Fifty-seven age-matched subjects without vestibular symptoms were examined as a control group (group C). SBF was detected in 11 (55%), 3 (20%) and 6 (11%) patients in groups A, B and C, respectively. Lacunae of the brainstem were found in 7 (35%) patients in group A and 1 (7%) in group B. The higher incidence of SBF in group A suggested a possible relationship between SBF and apogeotrophic type of DCPN. Apogeotrophic type of DCPN associated with SBF was considered to be caused by ischemia in the posterior circulation, though it was unclear whether the vestibular labyrinth or the hindbrain was mainly involved.