Nystagmus: Difference between revisions
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==Background== | ==Background== | ||
*Nystagmus = involuntary eye movement | *Nystagmus = involuntary eye movement | ||
*The semicircular canals of the vestibules and the extraocular muscles of the eye function together physiologically to help control gaze | *The semicircular canals of the vestibules and the extraocular muscles of the eye function together physiologically to help control gaze when the head is in motion | ||
*Nystagmus is an aberration in this stabilization of the ocular muscles when in motion | *Nystagmus is an aberration in this stabilization of the ocular muscles when the head is in motion | ||
==Clinical Features== | ==Clinical Features== | ||
Line 12: | Line 12: | ||
*Optic nerve hypoplasia | *Optic nerve hypoplasia | ||
*Macular disease | *Macular disease | ||
*Noonan syndrome | *[[Eponyms (M-P)#Noonan's syndrome|Noonan syndrome]] | ||
===Acquired Nystagmus=== | ===Acquired Nystagmus=== | ||
Line 21: | Line 21: | ||
*[[Meniere's disease]], [[BPPV]], [[labyrinthitis]], [[Vestibular Neuritis]] | *[[Meniere's disease]], [[BPPV]], [[labyrinthitis]], [[Vestibular Neuritis]] | ||
*[[Multiple sclerosis]] | *[[Multiple sclerosis]] | ||
*[[ | *[[Wernicke-Korsakoff syndrome]], [[thiamine deficiency]] | ||
*Tox causes: | *Tox causes: | ||
**[[Alcohol intoxication]], [[benzodiazepines]], [[barbiturates]], [[GHB]] | **[[Alcohol intoxication]], [[benzodiazepines]], [[barbiturates]], [[GHB]] | ||
*[[Ketamine]], [[Phencyclidine]] | **[[Ketamine]], [[Phencyclidine]] | ||
*[[Amphetamines]], [[MDMA]] | **[[Amphetamines]], [[Ecstasy (MDMA) toxicity|MDMA]] | ||
*[[Marijuana]] | **[[Marijuana]] | ||
*[[Lithium]] | **[[Lithium]] | ||
*[[Phenytoin]], [[fosphenytoin]], [[carbamazepine]], [[oxcarbazepine]], [[lacosamide]], [[gabapentin]] | **[[Phenytoin]], [[fosphenytoin]], [[carbamazepine]], [[oxcarbazepine]], [[lacosamide]], [[gabapentin]] | ||
*[[Salicylates]], [[NSAID toxicity]] | **[[Salicylates]], [[NSAID toxicity]] | ||
==Evaluation== | ==Evaluation== |
Latest revision as of 14:22, 18 September 2019
Background
- Nystagmus = involuntary eye movement
- The semicircular canals of the vestibules and the extraocular muscles of the eye function together physiologically to help control gaze when the head is in motion
- Nystagmus is an aberration in this stabilization of the ocular muscles when the head is in motion
Clinical Features
- Rapid, uncontrolled, rhythmic oscillation of the eye
- May be horizontal, vertical, and/or rotary
Differential Diagnosis
Congenital Nystagmus
- Optic nerve hypoplasia
- Macular disease
- Noonan syndrome
Acquired Nystagmus
- Head trauma, tympanic membrane rupture
- Brain tumor
- Stroke
- Chiari malformation
- Meniere's disease, BPPV, labyrinthitis, Vestibular Neuritis
- Multiple sclerosis
- Wernicke-Korsakoff syndrome, thiamine deficiency
- Tox causes:
Evaluation
- Differentiate monocular vs. binocular
- Monocular suggests medial pontine stroke or medial longitudinal fasciculus damage
- Look for contralateral internuclear opthalmoplegia (INO)
- Differentiate between central versus peripheral lesions[1]
Central | Peripheral |
Pure vertical, pendular, or rotary | Horizontal |
Fast beat towards lesions | Fast beat away from lesion |
Not relieved by gaze fixation | Relieved by gaze fixation |
Cerebellar signs | No cerebellar signs |
Optokinetic Drum Test
- Optokinetic reflex develops ~6 months of age
- Slow pursuit of eyes towards direction of vertical bar movement with quick saccade towards the opposite side to find the next bar to fixate on
- Abnormal in congenital nystagmus
- In parietal or parietal-occipital lesions, optokinetic nystagmus is impaired when the drum is rotated towards side of lesion
"H in space" Test
- Trace H in space
Caloric Reflex Test (also known as Vestibular Caloric Stimulation)
- The best clinical test for the Vestibulo-Optic reflex
- Water irrigated into the external auditory canal will exaggerate nystagmus if present
- Temperature of the irrigated water will control the direction.
- Cold water will exaggerate a nystagmus to move contralaterally
- Warm water will exaggerate a nystagmus to move ipsilaterally
COWS: Cold Opposite, Warm Same.
Management
Stabilize patient and manage primary cause of illness.
Disposition
See Also
External Links
References
- ↑ Bardorf CM et al. Acquired Nystagmus Clinical Presentation. Updated My 13, 2016. http://emedicine.medscape.com/article/1199177-clinical?src=refgatesrc1#b4.