Ictal Downbeat Nystagmus in Cardiogenic Vertigo

Rotatory vertigo mostly develops in vestibular disorders while presyncopal dizziness usually reflects generalized cerebral ischemia due to a cardiovascular cause.1 Nevertheless, contrary to established wisdom, patients with cardiovascular disorders frequently report vertigo.1,–,3 However, the mechanism of so-called cardiogenic vertigo remains unknown. Furthermore, no study has explored vestibular dysfunction during a spontaneous episode in a patient with cardiogenic vertigo. The previous studies of induced syncope suggest that the vertigo may result from cerebellar ischemia and vestibular function was in fact assessed in one of these studies.4,5 We observed downbeat nystagmus during the presyncopal attack with vertigo in a patient with recurrent asystole due to sick sinus syndrome. ### Case report. A 67-year-old woman presented with recurrent rotatory vertigo, nausea, and palpitation for 3 months. The patient reported that the vertigo had lasted for 5–10 seconds, and occurred 2–3 times per week, which became more frequent for the previous several days. She had a history of mitral valve replacement 10 years before. Between the episodes, the …