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Neuro-Malloy > Nystagmus > Flashcards

Nystagmus Flashcards

1
Q

What does a pendular nystagmus look like?

A

equal movement

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2
Q

What does a jerk nystagmus look like?

A

slow and fast component

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3
Q

True nystagmus is ______ and does not _____.

A

binocular, fatigue

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4
Q

Waveform describes…?

A

The movement of the nystagmus

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5
Q

Amplitude describes?

A

How much movement

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6
Q

Frequency describes ?

A

how many times it’s moving

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7
Q

Nystagmus is named after what phase?

A

The fast phase

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8
Q

When doing DO, the ONH slowly moves down and quickly moves up. What’s the front of the eye doing? What type of nystagmus is this?

A
  • front of the eye slowly moves up and quickly moves down

- downbeat nystagmus

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9
Q

What are the 3 main causes of nystagmus?

A
  1. Infarction
  2. Injury
  3. Demyelination
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10
Q

A congenital nystagmus will have what type of waveform?

A
  1. Horizontal

2. . Jerk or Pendular

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11
Q

A congenital nystagmus in a 1-4mo baby will look like what?

A
  • triangular wave form

- small amps, higher frequency

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12
Q

A congenital nystagmus will look like what at 7-18 mos?

A
  • jerk waveform
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13
Q

Describe the acronymn SLOW FUN for a congenital nystagmus.

A
  1. Symptomless
  2. Latent component
  3. abnormal OKN
  4. mixed Waveform (jerk/pendular)
  5. worse during Fixation
  6. horizontal in Upgaze
  7. better in Null zone
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14
Q

Describe the latent component of a congenital nystagmus.

A

When you cover one eye, the fixating eye will beat away from the covered eye (you’ll notice it on VAs)

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15
Q

Where is the null zone for a congenital nystagmus?

A

Usually convergence

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16
Q

What are the management options for a congenital nystagmus?

A
  • Pt is symptomless, so they don’t think they need to try anything
  • CLs
  • BO prism/-1.00 sphere = puts pt in null zone
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17
Q

What is the triad for Spasmus Nutans?

A
  1. Nystagmus
  2. Head nod
  3. Head tilt
    - but doesn’t always present like this
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18
Q

When does the head not go away?

A

When in supine position and sleeping

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19
Q

What is the waveform for spasmus nutans?

A
  • horizontal
  • vertical
  • torsional
  • pendular
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20
Q

What is the amplitude and frequency for spasmus nutans?

A
  • Low amplitude
  • High frequency
    (small, quick movements)
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21
Q

When is the onset of spasmus nutans? What’s the duration?

A
  • Onset = 4-12 months of age

- Duration = < 12 months (should resolve)

22
Q

When should a patient recover from spasmus nutans? What if they don’t?

A
  • Pt should recover by 2 years old

- If > 2, must perform imaging to check pathology

23
Q

This type of nystagmus occurs when you have someone look to the limit of their gaze. If you bring the gaze in by 30 degrees, it goes away.

A

Physiologic Gaze Evoked Nystagmus

24
Q

What are the horizontal gaze centers?

A
  • CN VI nuclei

- PPRF

25
Q

In a pathologic gaze evoked nystagmus, it is do to ______ force of the muscle tonus.

A

Unequal force

26
Q

In a pathologic gaze evoked nystagmus, the eye will drift ____ toward the stronger side, and ___ toward the weaker side.

A
  • slowly toward stronger side
  • fast toward weaker side
    (fast phase always toward weaker side)
27
Q

If the fast phase of a nystagmus is to the right, what side is weaker?

A

right gaze center is weaker

28
Q

When nystagmus is asymmetric between right and left gazes, you must think its ______.

A

pathologic (i.e. more nystagmus found in right gaze than in left)

29
Q

In vestibular nystagmus, the eye will drift _____ toward the weaker side and _____ toward the stronger side.

A
  • slowly toward the weaker side

- fast toward the stronger side

30
Q

In vestibular nystagmus, the fast phase will be _____ from the weaker side.

A

away

31
Q

In gaze-evoked nystagmus, the fast phase will be _____ the weaker side.

A

toward

32
Q

What type of vestibular nystagmus presents when the patient has a sudden onset of double vision and vertigo (dizziness) when they woke up in the morning.

A

Peripheral (vestibular nerve)

33
Q

How long does a peripheral VN last vs. central VN?

A
  • Peripheral = 4 weeks

- Central = forever

34
Q

What is the direction of the VN in peripheral vs .central?

A
  • Peripheral = horizontal and torsional

- Central = anything

35
Q

What type of nystagmus every so often switches direction?

A

Periodic Alternating Nystagmus

36
Q

What is the waveform of periodic alternating nystagmus?

A

Reversing, Horizontal, Jerk (not vertical)

37
Q

What is the main cause of periodic alternating nstagmus? Treatment?

A
  • Arnold-Chiari Malformation

- Baclofen

38
Q

Downbeat nystagmus is worse in what gaze?

A
  • worse in downgaze (fast phase is down)

- if chiari malformation = worse in downgaze and lateral gaze

39
Q

What’s the tx for downbeat nystagmus?

A
  • base down prism
40
Q

Upbeat nystagmus is worse in what gaze? What’s the tx?

A
  • worse in upgaze
  • fast phase is up
  • tx w/ base up prism
41
Q

What can make upgaze nystagmus worse that the patient can control?

A
  • tobacco use or smoking
42
Q

What is the waveform for see-saw nystagmus? Amplitude? Frequency?

A
  • WF = Pendular - same speed in both directions
  • Amp = high (alot of movement)
  • Freq = low (slow back and forth motion)
43
Q

Where does a lesion localize to that causes see-saw nystagmus?

A

Interstitial nucleus of cajal (midbrain)

44
Q

In see saw nystagmus, the higher eye ____ and the lower eye ____.

A

higher eye = intorts

lower eye = extorts

45
Q

What is the best treatment for a see-saw nystagmus? What about other options?

A 
Best = Patching one eye
Other = BO prism (null point of convergence), sunglasses
46
Q

What is the main cause of see-saw nystagmus?

A

Parasellar and sellar tumors

47
Q

When a patient presents with the roof of the mouth (palate) moving up and down with the same pendular motion as the eyes, what is this called?

A

Oculopalatal Myoclonus - eyes and tongue will have same movement

48
Q

What is the waveform for oculopalatal nystagmus?

A

vertical and pendular

49
Q

This type of nystagmus is a very fast, subtle INTORTING motion, not constant.

A

Superior Oblique Myokemia

- high frequency, low amplitude

50
Q

What is the cause of SO Myokemia? Tx?

A

CN IV nuclear irritation

Tx with BD prism

Neuro-Malloy (16 decks)

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