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Central compensation of deviated subjective visual vertical in Wallenberg’s syndrome
  1. Christian Daniel Cnyrim1,
  2. Nicole Rettinger1,
  3. Ulrich Mansmann2,
  4. Thomas Brandt1,
  5. Michael Strupp1
  1. 1Department of Neurology, University of Munich, Munich, Germany
  2. 2Institute for Medical Informatics, Biometry and Epidemiology, Munich, Germany
  1. Correspondence to:
 C D Cnyrim
 Department of Neurology, University of Munich, Marchioninistr. 15, D-81377 Munich, Germany;christian.cnyrim{at}


The central compensation of vestibular tonus imbalance due to unilateral peripheral vestibular lesions has been repeatedly documented. Little is known, however, about the central compensation of vestibular tonus imbalance due to central lesions. Dorsolateral medullary infarctions (Wallenberg’s syndrome) typically cause a central vestibular tonus imbalance in the roll plane with deviations of perceived verticality and ipsiversive body lateropulsion. The course of normalisation of the tilts of subjective visual vertical (SVV) in 50 patients who had acute Wallenberg’s syndrome were retrospectively compared with that in 50 patients with acute vestibular neuritis. The initial displacement of SVV was 9.8° in Wallenberg’s syndrome and 7° in vestibular neuritis. The deviation of SVV significantly decreased over time within days to weeks in both groups. This finding shows that the time courses of the central compensation for dorsolateral medullary infarctions and peripheral vestibular lesions are similar.

  • SVV, subjective visual vertical

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  • Competing interests: None declared.