Positional Alcohol Nystagmus in Patients with Unilateral and Bilateral Labyrinthine Destructions

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Abstract
Patients with bilateral or unilateral loss of their labyrinthine function were given ethyl alcohol in doses which in healthy subjects produce positional alcohol nystagmus (PAN), PAN being recorded electronystagmographically. In 7 patients with bilateral loss of labyrinthine function no PAN could be elicited in spite of maximal blood alcohol concentrations of 55 to 120 mg% and all other signs and symptoms of alcohol intoxication being present. In 8 patients with unilateral loss of labyrinthine function an initial, spontaneous nystagmus prior to experimentation was recorded behind closed eyelids. Alcohol administered in doses producing maximal blood alcohol levels of 40 to 120 mg% changed the spontaneous nystagmus into a positional alcohol nystagmus (PAN) of typical pattern. The intensity of these changes was correlated to the blood alcohol level and to the time after intake, higher levels being accompanied by more pronounced changes. The nystagmus with regard to direction and intensity at any moment was the "algebraic sum" of the spontaneous and the alcohol-induced nystagmus, hence changing with the position of the head and the time course of PAN I and PAN II respectively, i.e. in agreement with the time course of PAN I and PAN II in healthy subjects. Depending on the direction and intensity of the initial spontaneous nystagmus and the time course of the alcohol-induced positional nystagmus the nystagmus could be increased, diminished, abolished or even reversed. When correction is made for the direction and intensity of the spontaneous nystagmus, which can be looked upon as the reference level, PAN I as well as PAN II were observed in these patients with unilateral labyrinth damage in both the right and left lateral positions of the head with about the same intensity as in healthy subjects. It is infer red that the positional alcohol nystagmus (PAN) in man elicited by alcohol in-positional alchol nystagmus (PAN) in man elicited by alcohol intake must be due to a dual nervous system mechanism, involving a "central" and a "peripheral" component", the peripheral component requiring at least one functioning labyrinth.

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