Neurology Book



Aka: Nystagmus, Spontaneous Nystagmus, Horizontal Nystagmus, Vertical Nystagmus, Lateral Nystagmus, Direction Changing Nystagmus
  1. See Also
    1. Neurologic Anatomy of the Eye
    2. Eye Neurologic Exam
    3. Eye Anatomy
    4. Oculocephalic Reflex
    5. Nystagmus
    6. Eye Deviation
    7. Extraocular Movement
  2. Definitions
    1. Nystagmus
      1. Repetitive, oscillating movement of the eyes
    2. Direction of Nystagmus
      1. Named for quick component of Nystagmus
      2. Right Nystagmus suggests a left-sided lesion, and left Nystagmus a right-sided lesion
    3. Speed
      1. Slow Nystagmus: <40 jerks per minute
      2. Fast Nystagmus: >100 jerks per minute
    4. Amplitude
      1. Fine Nystagmus: <1 mm
      2. Coarse Nystagmus: >3 mm
    5. Involvement
      1. Associated Involvement: Bilateral eyes
      2. Dissociated Involvement: Unilateral eye
  3. Background
    1. Nystagmus is a slow involuntary eye movement in one direction, and then rapidly in the opposite direction
    2. Nystagmus is typically in the horizontal plane (right or left)
      1. Occurs normally on looking laterally
      2. Atypical findings include vertical or rotary Nystagmus
    3. Nystagmus is seen in Vertigo
      1. Most cases are peripheral (e.g. BPPV, Vestibular Neuronitis)
      2. Central cause (e.g. stroke) may be indicated by vertical or Direction Changing Nystagmus
    4. Nystagmus can be provoked
      1. Head turning
      2. Cold Calorics
        1. Infusing cold water into an ear
        2. Allows for testing the Cerebral Hemispheres and Brainstem in coma
  4. Indication: Vertigo Evaluation
    1. Absent Nystagmus in severe Acute Vestibular Syndrome (AVS) or Vertigo is unusual
      1. Casts doubt on the symptom (consider other causes of Dizziness)
  5. Exam
    1. Midline gaze
      1. Observe for Spontaneous Nystagmus with the patient looking straight ahead
    2. Smooth Pursuit
      1. Patient follows examiners finger in all directions as the examiner moves the finger slowly up, down, left and right
      2. Observe for Nystagmus
    3. Lateral gaze
      1. Patient looks at the examiner's finger placed >60 degrees from midline
      2. Observe for Nystagmus (common, even in the absence of pathology)
  6. Interpretation: Normal Findings - Lateral gaze Nystagmus
    1. Associated with stretch receptor
    2. All patients have a few beats of end point Nystagmus
  7. Interpretation: Abnormal Findings
    1. Spontaneous on Forward gaze, on moderate lateral gaze
    2. Direction
      1. Horizontal Nystagmus
        1. May indicate either peripheral disease or Central DIsease
        2. Unilateral vestibular pathology
      2. Vertical Nystagmus (or torsional Nystagmus)
        1. Indicates Central DIsease
        2. Brain Stem lesion
      3. Direction Changing Nystagmus
        1. Rightward Nystagmus with rightward gaze and leftward Nystagmus with leftward gaze
        2. Suggestive of central Vertigo (e.g. posterior CVA)
    3. Other abnormal findings
      1. Peduncular Nystagmus
        1. Eyes move at equal speeds in both directions
        2. Seen in congenital disorders or with prolonged blindness
  8. Causes: Nystagmus in Infants and Children
    1. Albinism (iris and Retinal Hypopigmentation)
    2. Bilateral Optic Nerve hypoplasia
      1. Seen in de Morsier's Syndrome
    3. Bilateral media opacities
    4. Achromatopsia
    5. Usher's Syndrome (Retinitis Pigmentosa)
  9. References
    1. Kattah (2009) Stroke 40: 3504-10 [PubMed]

Nystagmus (C0028738)

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, ガンシン, ガンシンショウサイフメイ, ガンシン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
Czech Nystagmus, Nystagmus NOS, Nystagmus, blíže neurčený, patologický nystagmus, nystagmus patologický
Polish Oczopląs pionowy, Oczopląs patologiczny, Oczopląs poziomy
Hungarian Nystagmus k.m.n., Nystagmus, nem meghatározott, Nystagmus
Norwegian Nystagmus, Patologisk nystagmus
Derived from the NIH UMLS (Unified Medical Language System)

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, シカクシャダンセイガンシン
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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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