II. Definitions
- Nystagmus
- Repetitive, oscillating movement of the eyes
- Direction of Nystagmus
- Named for quick component of Nystagmus
- Right Nystagmus suggests a left-sided lesion, and left Nystagmus a right-sided lesion
- Speed
- Slow Nystagmus: <40 jerks per minute
- Fast Nystagmus: >100 jerks per minute
- Amplitude
- Fine Nystagmus: <1 mm
- Coarse Nystagmus: >3 mm
- Involvement
- Associated Involvement: Bilateral eyes
- Dissociated Involvement: Unilateral eye
III. Background
- Nystagmus is a slow involuntary eye movement in one direction, and then rapidly in the opposite direction
- Nystagmus is typically in the horizontal plane (right or left)
- Occurs normally on looking laterally
- Atypical findings include vertical or rotary Nystagmus
- Nystagmus is seen in Vertigo
- Most cases are peripheral (e.g. BPPV, Vestibular Neuronitis)
- Central cause (e.g. stroke) may be indicated by vertical or Direction Changing Nystagmus
- Nystagmus can be provoked
- Head turning
- Cold Calorics
- Infusing cold water into an ear
- Allows for testing the Cerebral Hemispheres and Brainstem in coma
IV. Indication: Vertigo Evaluation
- Absent Nystagmus in severe Acute Vestibular Syndrome (AVS) or Vertigo is unusual
- Casts doubt on the symptom (consider other causes of Dizziness)
V. Exam
- Midline gaze
- Observe for Spontaneous Nystagmus with the patient looking straight ahead
- Smooth Pursuit
- Patient follows examiners finger in all directions as the examiner moves the finger slowly up, down, left and right
- Observe for Nystagmus
- Lateral gaze
- Patient looks at the examiner's finger placed >60 degrees from midline
- Observe for Nystagmus (common, even in the absence of pathology)
VI. Interpretation: Normal Findings - Lateral gaze Nystagmus
- Associated with stretch receptor
- All patients have a few beats of end point Nystagmus
VII. Interpretation: Abnormal Findings
- Spontaneous on Forward gaze, on moderate lateral gaze
- Direction
- Horizontal Nystagmus
- May indicate either peripheral disease or Central DIsease
- Unilateral vestibular pathology
- Vertical Nystagmus (or torsional Nystagmus)
- Indicates Central DIsease
- Brain Stem lesion
- Direction Changing Nystagmus
- Rightward Nystagmus with rightward gaze and leftward Nystagmus with leftward gaze
- Suggestive of central Vertigo (e.g. posterior CVA)
- Horizontal Nystagmus
- Other abnormal findings
- Peduncular Nystagmus
- Eyes move at equal speeds in both directions
- Seen in congenital disorders or with prolonged blindness
- Peduncular Nystagmus
VIII. Causes: Nystagmus in Infants and Children
- Albinism (iris and Retinal Hypopigmentation)
- Bilateral Optic Nerve hypoplasia
- Seen in de Morsier's Syndrome
- Bilateral media opacities
- Achromatopsia
- Usher's Syndrome (Retinitis Pigmentosa)
IX. References
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Related Studies
| Definition (CHV) | involuntary, rapid, rhythmic movement of the eyeball |
| Definition (NCI_CTCAE) | A disorder characterized by involuntary movements of the eyeballs. |
| Definition (NCI) | Involuntary movements of the eyeballs. The presence or absence of nystagmus is often used in the diagnosis of a variety of neurological and visual disorders. |
| Definition (MSH) | Involuntary movements of the eye that are divided into two types, jerk and pendular. Jerk nystagmus has a slow phase in one direction followed by a corrective fast phase in the opposite direction, and is usually caused by central or peripheral vestibular dysfunction. Pendular nystagmus features oscillations that are of equal velocity in both directions and this condition is often associated with visual loss early in life. (Adams et al., Principles of Neurology, 6th ed, p272) |
| Definition (PSY) | Eye movement reflex stabilizing the retinal image of a visual stimulus to compensate for head or stimulus movement. Also, eye movement defects resulting from neurological, muscular, or genetic disorders. |
| Definition (CSP) | involuntary, rapid, rhythmic movement of the eyeball. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D009759 |
| ICD9 | 379.50 |
| ICD10 | H55.00 , H55.0 |
| SnomedCT | 194171007, 194172000, 267750005, 155205009, 563001 |
| French | NYSTAGMUS, Nystagmus SAI, Nystagmus, non précisé, Nystagmus, Nystagmus pathologique |
| English | NYSTAGMUS, Nystagmus, unspecified, nystagmus (physical finding), nystagmus, Nystagmus NOS, Nystagmus, Pathologic, Pathologic Nystagmus, Unspecified nystagmus, Nystagmus, Pathologic [Disease/Finding], nystagmus (diagnosis), Unspecified nystagmus (disorder), Nystagmus (disorder), Nystagmus, NOS, Nystagmus |
| Portuguese | NISTAGMO, Nistagmo NE, Nistagmo Rotativo, Nistagmo, Nistagmo Patológico |
| Spanish | NISTAGMO, Nistagmus NEOM, Nistagmus no especificado, nistagmo no especificado, nistagmus no especificado, nistagmo no especificado (trastorno), nistagmo (trastorno), nistagmo, Nistagmus, Nistagmo Patológico |
| German | NYSTAGMUS, Nystagmus, unspezifisch, Nystagmus NNB, Nystagmus, Nystagmus, pathologischer |
| Italian | Nistagmo, Nistagmo NAS, Nistagmo, non specificato, Nistagmo patologico |
| Dutch | niet-gespecificeerde nystagmus, nystagmus NAO, nystagmus, Nystagmus, pathologische, Pathologische nystagmus |
| Japanese | 眼振ＮＯＳ, 眼振、詳細不明, ｶﾞﾝｼﾝ, ｶﾞﾝｼﾝｼｮｳｻｲﾌﾒｲ, ｶﾞﾝｼﾝNOS, 眼球振盪, 周期性交代眼振, 垂直眼振, 輻輳眼振, 振子様眼振, 眼振-病的, 眼球振とう, 眼球振盪症, 水平眼振, ニスタグムス, シーソー眼振, 律動眼振, 病的眼振, 回旋眼振, 眼振 |
| Swedish | Nystagmus, patologisk |
| Finnish | Silmävärve |
| Russian | NISTAGM PATOLOGICHESKII, NISTAGM, НИСТАГМ, НИСТАГМ ПАТОЛОГИЧЕСКИЙ |
| Czech | Nystagmus, Nystagmus NOS, Nystagmus, blíže neurčený, patologický nystagmus, nystagmus patologický |
| Croatian | NISTAGMUS, PATOLOŠKI |
| Polish | Oczopląs pionowy, Oczopląs patologiczny, Oczopląs poziomy |
| Hungarian | Nystagmus k.m.n., Nystagmus, nem meghatározott, Nystagmus |
| Norwegian | Nystagmus, Patologisk nystagmus |
Ontology: Spontaneous Ocular Nystagmus (C0271384)
| Concepts | Disease or Syndrome (T047) |
| MSH | D009759 |
| ICD9 | 379.53 |
| ICD10 | H55.03 |
| SnomedCT | 246784009, 39771000, 45339001 |
| Dutch | nystagmus door gezichtsverlies |
| French | Nystagmus avec déprivation visuelle, Nystagmus oculaire spontané |
| German | Nystagmus bei Schwachsichtigkeit |
| Italian | Nistagmo da deprivazione visiva, Nistagmo oculare spontaneo |
| Portuguese | Nistagmo de privação visual |
| Spanish | Nistagmus por privación visual, nistagmo ocular espontáneo (concepto no activo), nistagmo ocular espontáneo, nistagmo amaurótico, nistagmo ocular, nistagmo por deprivación visual (trastorno), nistagmo por deprivación visual |
| Japanese | 視覚遮断性眼振, ｼｶｸｼｬﾀﾞﾝｾｲｶﾞﾝｼﾝ |
| English | Spontaneous eye movem assoc with binoc visual loss, Spon eye move, binoc vis loss, visual deprivation nystagmus (diagnosis), visual deprivation nystagmus, Nystagmus, Spontaneous Ocular, Ocular Nystagmus, Spontaneous, Visual deprivatn nystagm, roving eye movements, ocular nystagmus, Searching eye movements (finding), Spontaneous ocular nystagmus (disorder), Visual deprivation nystagmus, Spontaneous ocular nystagmus, Amaurotic nystagmus, Searching eye movements, Ocular nystagmus, Roving eye movements, Spontaneous eye movements associated with binocular visual loss, Visual deprivation nystagmus (disorder), Spontaneous Ocular Nystagmus |
| Czech | Nystagmus z poruchy zraku, optokinetický nystagmus spontánní |
| Hungarian | Tekintési deprivációs nystagmus |
| Norwegian | Spontan nystagmus |
Ontology: Horizontal Nystagmus (C0271385)
| Concepts | Disease or Syndrome (T047) |
| MSH | D009759 |
| SnomedCT | 81756001 |
| English | Nystagmus, horizontal, Horiz central vestib nystagm, horizontal nystagmus, horizontal nystagmus (physical finding), horizontal nystagmus was observed, Nystagmus, Horizontal, Horizontal nystagmus, Horizontal central vestibular nystagmus, Horizontal nystagmus (disorder), Horizontal Nystagmus |
| Portuguese | Nistagmo Horizontal |
| Spanish | Nistagmo Horizontal, nistagmo horizontal (trastorno), nistagmo horizontal |
| French | Nystagmus horizontal |
| German | Horizontaler Nystagmus |
| Czech | horizontální nystagmus |
| Norwegian | Horisontal nystagmus |
| Italian | Nistagmo orizzontale |
| Dutch | Horizontale nystagmus |
Ontology: Vertical Nystagmus (C0271386)
| Concepts | Disease or Syndrome (T047) |
| MSH | D009759 |
| SnomedCT | 111533001 |
| Portuguese | Nistagmo Vertical |
| Spanish | Nistagmo Vertical, nistagmo vertical (trastorno), nistagmo vertical |
| French | Nystagmus vertical |
| German | Vertikaler Nystagmus |
| English | Nystagmus, Vertical, Vertical nystagmus, Vertical nystagmus (disorder), Vertical Nystagmus |
| Czech | vertikální nystagmus |
| Norwegian | Vertikal nystagmus |
| Italian | Nistagmo verticale |
| Dutch | Verticale nystagmus |
