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Positional nystagmus and vertigo due to a solitary brachium conjunctivum plaque
  1. E Anagnostou1,
  2. D Mandellos1,
  3. G Limbitaki2,
  4. A Papadimitriou2,
  5. D Anastasopoulos1,2
  1. 1Department of Physiology, School of Nursing, University of Athens, Greece
  2. 2Department of Neurology, “Henry Dunant” Hospital of the Greek Red Cross, Athens, Greece
  1. Correspondence to:
 Dr D Anastasopoulos
 8 Tetrapoleos Str, Goudi, Athens, Greece; danastas{at}


The authors describe two patients suffering from demyelinating central nervous system disease who developed intense vertigo and downbeat nystagmus upon tilting their heads relative to gravity. Brain MRI revealed in both cases a single, small active lesion in the right brachium conjunctivum. The disruption of otolithic signals carried in brachium conjunctivum fibres connecting the fastigial nucleus with the vestibular nuclei is thought to be causatively involved, in agreement with a recently formulated model simulating central positional nystagmus. Insufficient otolithic information results in erroneous adjustment of the Listing’s plane in off-vertical head positions, thus producing nystagmic eye movements.

  • MLF, medial longitudinal fasciculus
  • VOR, vestibuloocular reflex
  • brachium conjunctivum
  • positional nystagmus
  • Listing’s law

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  • Competing interests: None.