Ipsilateral beating nystagmus after acoustic schwannoma resection

Objective: To highlight the alert value of an ipsilateral beating nystagmus to detect any potential vascular complication in the early postoperative course of acoustic schwannoma (AS) surgery. Methods: In a series of 432 cases of AS operated by the same surgeons between January 1991 and December 2000, two cases of vascular complications were detected by an ipsilateral beating nystagmus toward the operated side. Results: One case of arterial infarction giving rise to a partial AICA syndrome and one case of hematoma of the cerebello-pontine angle (CPA) were revealed by an ipsilateral beating nystagmus. It was the first or the only objective neurologic sign encountered in the early postoperative course of AS surgery. Conclusions: An ipsilateral beating nystagmus after AS resection, even appearing as the only abnormal objective neurologic finding, should always raise suspicion of a brain stem event. Early extubation is recommended for systematic neurologic assessment in order to detect as quickly as possible any potential vascular complication in the early postoperative course of AS.