Gaze-Evoked and Perverted Head-Shaking Nystagmus in a Patient with Polycythemia Vera

Abstract

Polycythemia vera (PV) is well known chronic myeloproliferative neoplasm, caused by clonal expansion of an abnormal hematopoietic stem cell. Patients with PV may present diverse neurologic symptoms including headache, dizziness or vertigo, tinnitus. However, the attention has not been directed to the neurootological findings in patients with PV. Here, we present a 71-year-old male patient with PV suffered from vertigo and headache. He demonstrated gaze-evoked nystagmus and perverted head shaking nystagmus. Transcranial Doppler showed decrement of blood flow velocity in posterior circulation. The patient’s neuro-otologic findings were normalized as polychethemia and blood flow improved with repetitive phlebotomy and medications such as hydroxyurea and aspirin. Considering the neurological and hemodynamic findings in our patient, the mechanism of vertigo in PV could be explained by central vestibulopathy because of vascular insufficiency rather than peripheral vestibulopathy because of inner ear blood hyperviscosity. Keywords: Nystagmus; Vertigo; Polycythemia vera; Transcranial Doppler 중심 단어: 안진, 어지럼증, ì§„ì„±ì í˜ˆêµ¬ì¦ê°€ì¦, 경두개초