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Motility Block 12 > Nystagmus II > Flashcards

Nystagmus II Flashcards

1
Q

Sensation of the environment moving

A

Oscillopsia

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2
Q

A feeling of being off balance

A

Vertigo

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3
Q

Position of gaze where eyes are quiet

A

Null point

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4
Q

Physiological nystagmus are all ____ nystagmus

A

Jerk

  • conjugate
  • no other symptoms
  • nothing else going on
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5
Q

End point nystagmus

A
  • Small amp, variable freq
  • intermittent conjugate jerk-fast phase in the direction of the gaze
  • can be worse when tired
  • seen in both eyes when an extreme lateral gaze is held for a prolonged time (greater than 30 degrees of midline)
  • symmetrical in right and left gaze
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6
Q

Sobriety test and nystagmus

A

You can fail this if you have a large nystagmus

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7
Q

What direction is the fast phase in endpoint nystagmus

A

In the direction of the gaze

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8
Q

Rotational nystagmus

A
  • jerk nystagmus due to the head to body rotation
  • related to the endolymph in the semicircular canals
  • normal response is slow conjugate eye movement when fast phase opposite the rotation
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9
Q

Caloric nystagmus

A
  • conjugate, jerk nystagmus during the caloric testing of the vestibular system
  • cold water: fast towards opposite ear
  • warm water: fast phase towards ipsilaterl ear

COWS

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10
Q

Slow pursuits eye movement followed by a fast corrective saccade because a visual field moves over the retina

A

OKN

  • congujate movement maintinaing the image of the move Ig target on the fovea when the head is still
  • the fast corrective saccade is to fixate on a new stripe
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11
Q

OKN developed at what age

A

3-5 months

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12
Q

Congenital nystagmus and OKN

A

They will show the reverse OKN response and could show a preserved vertical OKN response

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13
Q

Could be used for malingering and uncooperative patients

A

OKN

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14
Q

Dissociated movements with excessive oscillations in the presence of other ocular motor abnormalities

A

Pathological

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15
Q

Congenital/infantile nystagmus

A
  • present at or shortly after birth
  • twice as frequency in boys than girls
  • may be present with strabismus
  • conjugate, horizontal, oscillopsia is not present
  • family history likely
  • afferent or efferent (mostly efferent,motor)
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16
Q

Congenital/infantile nystagmus is more common in which gender

A

Males

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17
Q

Oscillopsia in congenial/infantile

A

Not present

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18
Q

Details of congenital/infantile nystagmus

A
  • pendulum and/or jerk nystagmus (mainly)
  • mainly horizontal (even in vertical gaze)
  • conjugate
  • amplitude and frequency vary
  • active fixation, attention or anxiety can increase nystagmus
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19
Q

Head position in congenital/infantile nystagmus

A

There could be anomalous head position, if null point is not in primary

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20
Q

Null point in congenital/infantile nystagmus

A

Present, VA good at null point

-head turn or tilt is an attempt to decrease nystagmus

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21
Q

When does congenital/infantile nystagmus increase

A

With fixation, BUT dampened with convergence

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22
Q

How to decrease congenital nystagmus

A

Convergence

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23
Q

When one eye is covered in congenital nystagmus

A

Latent nystagmus usually seen when one eye is covered

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24
Q

Age and congenial nystagmus q

A

Could improve

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25
OKN in congenital/infantile nystagmus
It is in reverse -normal response is the fast phase in the opposite direction of the OKN drum, but in this, they go in the same direction as the drum
26
Afferernt etiology in congenital/infantile nystagmus
-inadequate image formation results in failure of development or normal fixation
27
Severity of the congenital nystagmus in afferent
Correlated to the degree of pathology/vision loss
28
Vision in someone with afferent etiology of congenital infantile nystagmus
Poorer vision, little prognosis for improvement
29
Pathology in afferent etiology in congenital infantile nystagmus
It is obvious on evaluation | -achromatopsia, anirisia, cataracts, ocular albinism, ON hyperplasia, or atrophy
30
When acuity is poor in afferent congenital infantile nystagmus
Consider optic atrophy, optic nerve hyperplasia, retinal dystrophy
31
Efferent congenial/infantile nystagmus
Fixation and/or motor issues Better VA than afferent Cosmesis concerns
32
Nystagmus blockage syndrome
- patient with congenital nystagmus that later develops esotropia - likely develops in patients with congenital nystagmus because of attempts to suppress nystagmus by converging - convergence usually dam opens congenital nystagmus
33
Nystagmus becomes absent or reduced on ____________ in nystagmus blockage syndrome
Addiction of the fixating eye
34
When does nystagmus increase
As fixating eye moves towards primary or into abduction
35
What does nystagmus blockage syndrome look like
May look like 6th nerve palsy, but there is ability to abduct the eye
36
Accommodation and nystagmus blockage syndrome
There can also be accommodative elements to the strabismus | -some hyperopia
37
Congenital, jerk nystagmus after occlusion of one eye
Latent nystagmus
38
Is latent nystagmus horizaontl or vertical
Horizontal
39
Fast phase in latent nystagmus
Fast phase towards the uncovered eye
40
Is latent nystagmus bad
Not really, benign, isolated, could be associated with strabismus (especially congenital esotropia) and amblyopia
41
When is latent nystagmus increased
With disruption of fusion
42
Monocular VA in latent nystagmus
Reduced
43
Binocular Va in latent nystagmus
Is better
44
When do you get left jerk latent nystagmus
When the right eye is covered (fast phase towards uncovered eye)
45
Can latent nystagmus happen with both eyes open?
Yes, but one eye is suppressed. This is call manifest latent nystagmus
46
Spasmus nutans
- starts shortly after birth - pendular nystagmus - bilateral and/or appear unilateral - usually reduced by age 5-8 - no long term sequelae-benign in most cases - could be associated with strabismus, amblyopia, and developmental delays
47
Characteristics of spasmus nutans
- small/fine amplitude - high frequency/fast (shimmering) nystagmus - head nodding - torticollis (in about 50% of patients) Head nodding and torticollis appears to be compensatory to maximize vision
48
What other disorders show similar movements as spasmus nutans
Chiasmal tumors, glioma, and craniopharyngeal and retinal dystrophies -there is a need for neurology and imaging if there is eveidence of optic nerve abnormalities
49
What happens in see saw nystagmus
It is pendular and one eye elevates and intorts while the other depresses and extorts (feature both vertical and torsional components) -alternate movements of elevation and into ration followed by depression and extortion
50
What is see saw nystagmus associated with
Lesion in the suprasellar area Or a craniopharyngioma in children -also seen in Joubert syndrome
51
When you see see-saw nystagmus what should you do
Send to neurology and radiology
52
Jerk vertical nystagmus in primary, fast phase beats down
Downbeat nystagmus
53
What is downbeat nystagmus due to
Due to Cranio-cervical junction abnormalities, such as chiari malformation
54
What should you do if you see downbeat nystagmus
Neurology now
55
What medications can cause downbeat nystagmus
Lithium, tranqs
56
Jerk vertical nystagmus, with fast phase up, due to brain stem abnormalities (within posterior fossa, and can be caused from drugs
Upbeat nystagmus
57
Horizontal nystagmus that is jerk with a rotary element. Associated with inner ear or vestibular abnormalities
Vestibular nystagmus
58
Symptoms of vestibular nystagmus
Oscillopsia, nauseas and vertigo because of the dysfunction of the vestibular system, hearing loss is common
59
Convergence-retraction syndrome
- rhythmic convergence and retraction of the eyes when attempting upgaze movement - not a true nystagmus because it doesn’t have a slow phase, but opposing addicting saccades - retraction occurs because of the contraction of all the EOM at the same time
60
What is associated with parinaud syndrome
Convergence-retraction
61
Dorsal midbrain Syndrome
Parinaud syndrome - protect all dysfunction - excess convergence - paralysis of upward gaze
62
Accompany neurological signs in parinaud syndrome
- palsy in upgaze - eyelid retraction - pupillary light-near dissociation - convergence retraction
63
Periodic alternating nystagmus
- rare, horizaontl - congenital or acquired - nystagmus changes direction every 90s with rest of about 10s - hallmark sign is the shifting null point - seen in degenerative processes involving cerebellum - can be associated with skew deviation - patient may have alternating head turnings to adapt - surgery may be indicated for congenial forms (horizaontl rectus reastrictions)
64
Voluntary nystagmus
- rapid with small amp and short duration - pendular - conjugate - horizaontl - produced voluntarily by the patient - may run in families - induced by convergence and there is oscillopsia - only maintained for a few secs because of fatigue - can be part of spasm of the near reflex

Motility Block 12 (4 decks)

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