Otolith manifestations in Wallenberg syndrome.

Central vestibular pathways issuing from the otolith may be involved in Wal lenberg syndrome, resulting in specific symptoms. These "otolith" symptoms are less well known than vestibular symptoms issuing from the canal. We rep ort 15 patients with Wallenberg syndrome who had one or more clinical signs suggestive of otolith pathway involvement. Clinical examination looked for . 1) perceptive signs like tilt of the subjective visual vertical and acute room tilt illusion; 2) postural signs like head tilt and axial lateropulsi on; 3) ocular signs like skew deviation, ocular lateropulsion and positiona l nystagmus. Static posturography and eye movement recordings were performe d. Eleven patients presented ipsilesional skew deviation; ipsilesional tilt of subjective visual vertical was found in 8 patients; a room tilt illusion w as described in 4 patients in either the frontal or the sagittal plane: 9 p atients presented axial lateropulsion toward the lesioned side; 8 patients presented ipsilesional ocular lateropulsion, 6 of them in association with axial lateropulsion. Finally, 3 patients presented positional nystagmus evo ked by head tilt in the roll or the pitch plane. Pathophysiology of these s ymptoms and evidence for an otolith pathway involvement are discussed.