A case of left-sided cerebellar-pontine angle gliobla-stoma multiforme with cerebellar gaze nystagmus and an irregular mixed nystagmus

Abstract

The patient was well until Feburary 1971, four months before admission when, at the age of 22, he noted abruptly the onset of dizziness, headache and diplopia. During the four months before admission, he experienced unsteadiness of gait, left sided sudden deafness, difficulty in swallowing, thick speech, urinary hesitancy, papilledema and a lack of co-ordination. Examination of the cranial nerves showed diminished left sided facial sensation including an absent left corneal reflex, left lateral rectus palsy, left facial palsy, left sided deafness, absent caloric response on the left side, left glossopharyngeal palsy and vagal palsy.At the time of the first surgery June 19, 1971, an egg-sized tumor was extirpated, (left sided cerbellarpontine angle) and the diagnosis of glioblastoma multiforme was made. Treatment with Co60 irradiation was initiated after the surgery, the patient was improving satisfactorily and was discharged on August 28, 1971. Subsequently he has been re-admitted twice.At the time of the second surgery November 2, 1972, atrophy of the left cerebellum was most evident.In the neuro-otological examinations of this patient, Bruns-Cushing type nystagmus was observed on admission June, 1971 and two months later the nystagmus changed to pendular nystagmus on leftward gaze. At the time of second surgery November 2, 1972, gaze nystagmus, like congenital nystagmus, spontaneous horizontal nystagmus to left side, and an irregular-mixed nystagmus in Frenzel glasses were observed. While the gaze nystagmus was thought to be associated with atrophy of the left cerebellum, as there were signs of tremor of eyeballs to the left gaze, spontaneous horizontal nystagmus to the left ceasing with eye closure or, in Frenzel glasses, and cerebellar findings of eye tracking and optokinetic tests, an irregullar-mixed nystagmus was probably mainly related to vestibular nuclei occurring with eyes closed or, in Frenzel glasses and from the clinical appearance. This vertical nystagmus was also thought to be related to lesions of cerebellar vermis, as the nystagmus was influenced by changes in the position of the head.