Vertical pendular nystagmus1
Synchronous rhythmic movements of the pharynx, face, tensor tympani, vocal cords,
shoulders, and respiratory muscles2
1. Pathogenesis of vertical pendular nystagmus: results from involvement of the Triangle of Guillain and
Mollaret, which consists of:
■ Red nucleus in the midbrain (which projects to the inferior olivary nucleus via the central tegmental tract)
■ Inferior olivary nucleus in the medulla (which projects to the contralateral dentate nucleus via the olivocerebellar tract in the inferior cerebellar peduncle)
■ Contralateral dentate nucleus in the cerebellum (which projects to the red nucleus via the superior cerebellar
Hypertrophic degeneration of inferior olivary nucleus (which contains increased acetylcholine-esterase reaction
product) is necessary but not sufficient for the genesis of the nystagmus
2. Pathogenesis of palatal tremor: results from rostral cerebellar or brainstem damage that denervates the dorsal
cap of inferior olivary nucleus.