Reader response: Teaching Video NeuroImages: Vestibulo-ocular reflex defect in cerebellar stroke

First, the lesion shown is not in the flocculonodular lobe, as suggested by the authors,1 but within the left cerebellar hemisphere, most likely in the superior cerebellar artery (SCA) territory.2 Among 41 SCA strokes reported by Drs. Lee and Kim,3 none had an abnormal HIT, only 11 had nystagmus, and those with nystagmus almost all had more ventrally located lesions. Thus, the clinical findings as described by Witsch et al. cannot readily be explained by the lesion shown. Other possibilities include missed brainstem stroke in the vestibular nucleus, labyrinthine infarction, vestibular neuritis with incidental stroke, old (and coincidental) vestibular loss, or erroneous clinical interpretation of the HIT findings.

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