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The cerebellar nodulus: Perceptual and ocular processing of graviceptive input

Current concepts postulate a decisive role of the cerebellar nodulus in the processing of otolith input. We hypothesized that nodular lesions abolish otolith‐perceptual integration, predicting alignment of perceived direction of earth vertical with the z‐axis of the head and not with gravity. In an 80‐year‐old patient with acute heminodular infarction, the subjective visual vertical deviated contralesionally by −21.1° when the patient was upright. After subtracting this offset, perceived vertical closely matched the patient's head orientation when the patient was roll‐tilted. Otolith‐ocular reflexes remained normal. This is the first report on abolished earth verticality perception in heminodular stroke and underlines the importance of the nodulus in spatial orientation. Ann Neurol 2015;77:343–347