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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
Q

OKN in congenital/infantile nystagmus

A

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

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26
Q

Afferernt etiology in congenital/infantile nystagmus

A

-inadequate image formation results in failure of development or normal fixation

27
Q

Severity of the congenital nystagmus in afferent

A

Correlated to the degree of pathology/vision loss

28
Q

Vision in someone with afferent etiology of congenital infantile nystagmus

A

Poorer vision, little prognosis for improvement

29
Q

Pathology in afferent etiology in congenital infantile nystagmus

A

It is obvious on evaluation

-achromatopsia, anirisia, cataracts, ocular albinism, ON hyperplasia, or atrophy

30
Q

When acuity is poor in afferent congenital infantile nystagmus

A

Consider optic atrophy, optic nerve hyperplasia, retinal dystrophy

31
Q

Efferent congenial/infantile nystagmus

A

Fixation and/or motor issues
Better VA than afferent
Cosmesis concerns

32
Q

Nystagmus blockage syndrome

A
  • 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
Q

Nystagmus becomes absent or reduced on ____________ in nystagmus blockage syndrome

A

Addiction of the fixating eye

34
Q

When does nystagmus increase

A

As fixating eye moves towards primary or into abduction

35
Q

What does nystagmus blockage syndrome look like

A

May look like 6th nerve palsy, but there is ability to abduct the eye

36
Q

Accommodation and nystagmus blockage syndrome

A

There can also be accommodative elements to the strabismus

-some hyperopia

37
Q

Congenital, jerk nystagmus after occlusion of one eye

A

Latent nystagmus

38
Q

Is latent nystagmus horizaontl or vertical

A

Horizontal

39
Q

Fast phase in latent nystagmus

A

Fast phase towards the uncovered eye

40
Q

Is latent nystagmus bad

A

Not really, benign, isolated, could be associated with strabismus (especially congenital esotropia) and amblyopia

41
Q

When is latent nystagmus increased

A

With disruption of fusion

42
Q

Monocular VA in latent nystagmus

A

Reduced

43
Q

Binocular Va in latent nystagmus

A

Is better

44
Q

When do you get left jerk latent nystagmus

A

When the right eye is covered (fast phase towards uncovered eye)

45
Q

Can latent nystagmus happen with both eyes open?

A

Yes, but one eye is suppressed. This is call manifest latent nystagmus

46
Q

Spasmus nutans

A
  • 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
Q

Characteristics of spasmus nutans

A
  • 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
Q

What other disorders show similar movements as spasmus nutans

A

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
Q

What happens in see saw nystagmus

A

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
Q

What is see saw nystagmus associated with

A

Lesion in the suprasellar area
Or a craniopharyngioma in children
-also seen in Joubert syndrome

51
Q

When you see see-saw nystagmus what should you do

A

Send to neurology and radiology

52
Q

Jerk vertical nystagmus in primary, fast phase beats down

A

Downbeat nystagmus

53
Q

What is downbeat nystagmus due to

A

Due to Cranio-cervical junction abnormalities, such as chiari malformation

54
Q

What should you do if you see downbeat nystagmus

A

Neurology now

55
Q

What medications can cause downbeat nystagmus

A

Lithium, tranqs

56
Q

Jerk vertical nystagmus, with fast phase up, due to brain stem abnormalities (within posterior fossa, and can be caused from drugs

A

Upbeat nystagmus

57
Q

Horizontal nystagmus that is jerk with a rotary element. Associated with inner ear or vestibular abnormalities

A

Vestibular nystagmus

58
Q

Symptoms of vestibular nystagmus

A

Oscillopsia, nauseas and vertigo because of the dysfunction of the vestibular system, hearing loss is common

59
Q

Convergence-retraction syndrome

A
  • 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
Q

What is associated with parinaud syndrome

A

Convergence-retraction

61
Q

Dorsal midbrain Syndrome

A

Parinaud syndrome

  • protect all dysfunction
  • excess convergence
  • paralysis of upward gaze
62
Q

Accompany neurological signs in parinaud syndrome

A
  • palsy in upgaze
  • eyelid retraction
  • pupillary light-near dissociation
  • convergence retraction
63
Q

Periodic alternating nystagmus

A
  • 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
Q

Voluntary nystagmus

A
  • 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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