Diferencia entre revisiones de «Nystagmus»
| (No se muestran 11 ediciones intermedias de 3 usuarios) | |||
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==Background== | ==Background== | ||
*The semicircular canals of the vestibules and the extraocular muscles of the eye function together physiologically to help control gaze | *Nystagmus = involuntary eye movement | ||
*Nystagmus is an aberration in this stabilization of the ocular muscles when in motion | *The semicircular canals of the vestibules and the extraocular muscles of the eye function together physiologically to help control gaze when the head is in motion | ||
*Nystagmus is an aberration in this stabilization of the ocular muscles when the head is in motion | |||
==Clinical Features== | ==Clinical Features== | ||
| Línea 9: | Línea 10: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
===Congenital Nystagmus=== | ===Congenital Nystagmus=== | ||
* Optic | *Optic nerve hypoplasia | ||
* Macular | *Macular disease | ||
*[[Eponyms (M-P)#Noonan's syndrome|Noonan syndrome]] | |||
===Acquired Nystagmus=== | ===Acquired Nystagmus=== | ||
* | *[[Head trauma]], [[tympanic membrane rupture]] | ||
* | *[[Brain tumor]] | ||
* [[Alcohol intoxication]] | *[[Stroke]] | ||
* [[ | *Chiari malformation | ||
* | *[[Meniere's disease]], [[BPPV]], [[labyrinthitis]], [[Vestibular Neuritis]] | ||
* [[ | *[[Multiple sclerosis]] | ||
* [[ | *[[Wernicke-Korsakoff syndrome]], [[thiamine deficiency]] | ||
* | *Tox causes: | ||
**[[Alcohol intoxication]], [[benzodiazepines]], [[barbiturates]], [[GHB]] | |||
**[[Ketamine]], [[Phencyclidine]] | |||
**[[Amphetamines]], [[Ecstasy (MDMA) toxicity|MDMA]] | |||
**[[Marijuana]] | |||
**[[Lithium]] | |||
**[[Phenytoin]], [[fosphenytoin]], [[carbamazepine]], [[oxcarbazepine]], [[lacosamide]], [[gabapentin]] | |||
**[[Salicylates]], [[NSAID toxicity]] | |||
==Evaluation== | ==Evaluation== | ||
*Differentiate monocular vs. binocular | |||
**Monocular suggests medial pontine stroke or medial longitudinal fasciculus damage | |||
**Look for contralateral [[internuclear opthalmoplegia]] (INO) | |||
*Differentiate between central versus peripheral lesions<ref>Bardorf CM et al. Acquired Nystagmus Clinical Presentation. Updated My 13, 2016. http://emedicine.medscape.com/article/1199177-clinical?src=refgatesrc1#b4.</ref> | |||
{| {{table}} | |||
| align="center" style="background:#f0f0f0;"|'''Central''' | |||
| align="center" style="background:#f0f0f0;"|'''Peripheral''' | |||
|- | |||
| Pure vertical, pendular, or rotary||Horizontal | |||
|- | |||
| Fast beat towards lesions||Fast beat away from lesion | |||
|- | |||
| Not relieved by gaze fixation||Relieved by gaze fixation | |||
|- | |||
| Cerebellar signs||No cerebellar signs | |||
|} | |||
===Optokinetic Drum Test=== | |||
*Optokinetic reflex develops ~6 months of age | |||
*Slow pursuit of eyes towards direction of vertical bar movement with quick saccade towards the opposite side to find the next bar to fixate on | |||
*Abnormal in congenital nystagmus | |||
*In parietal or parietal-occipital lesions, optokinetic nystagmus is impaired when the drum is rotated towards side of lesion | |||
**See [https://www.youtube.com/watch?v=UJVFFqZJKGo OKN drum to the right] | |||
**See [https://www.youtube.com/watch?v=rKm04X-gd2I&list=PLhVpkuPiEu3btjvIlCckXow7PNf5WHdsN OKN drum to the left] | |||
==="H in space" Test=== | ==="H in space" Test=== | ||
*Trace H in space | *Trace H in space | ||
| Línea 36: | Línea 68: | ||
==Management== | ==Management== | ||
Stabilize patient and manage primary | Stabilize patient and manage primary cause of illness. | ||
==Disposition== | ==Disposition== | ||
| Línea 42: | Línea 74: | ||
==See Also== | ==See Also== | ||
*[[Focal neurologic deficits]] | |||
==External Links== | ==External Links== | ||
| Línea 50: | Línea 82: | ||
<references/> | <references/> | ||
[[Category:Symptoms]] | [[Category:Symptoms]] [[Category:Neurology]] | ||
Revisión actual - 14:22 18 sep 2019
Background
- Nystagmus = involuntary eye movement
- The semicircular canals of the vestibules and the extraocular muscles of the eye function together physiologically to help control gaze when the head is in motion
- Nystagmus is an aberration in this stabilization of the ocular muscles when the head is in motion
Clinical Features
- Rapid, uncontrolled, rhythmic oscillation of the eye
- May be horizontal, vertical, and/or rotary
Differential Diagnosis
Congenital Nystagmus
- Optic nerve hypoplasia
- Macular disease
- Noonan syndrome
Acquired Nystagmus
- Head trauma, tympanic membrane rupture
- Brain tumor
- Stroke
- Chiari malformation
- Meniere's disease, BPPV, labyrinthitis, Vestibular Neuritis
- Multiple sclerosis
- Wernicke-Korsakoff syndrome, thiamine deficiency
- Tox causes:
Evaluation
- Differentiate monocular vs. binocular
- Monocular suggests medial pontine stroke or medial longitudinal fasciculus damage
- Look for contralateral internuclear opthalmoplegia (INO)
- Differentiate between central versus peripheral lesions[1]
| Central | Peripheral |
| Pure vertical, pendular, or rotary | Horizontal |
| Fast beat towards lesions | Fast beat away from lesion |
| Not relieved by gaze fixation | Relieved by gaze fixation |
| Cerebellar signs | No cerebellar signs |
Optokinetic Drum Test
- Optokinetic reflex develops ~6 months of age
- Slow pursuit of eyes towards direction of vertical bar movement with quick saccade towards the opposite side to find the next bar to fixate on
- Abnormal in congenital nystagmus
- In parietal or parietal-occipital lesions, optokinetic nystagmus is impaired when the drum is rotated towards side of lesion
"H in space" Test
- Trace H in space
Caloric Reflex Test (also known as Vestibular Caloric Stimulation)
- The best clinical test for the Vestibulo-Optic reflex
- Water irrigated into the external auditory canal will exaggerate nystagmus if present
- Temperature of the irrigated water will control the direction.
- Cold water will exaggerate a nystagmus to move contralaterally
- Warm water will exaggerate a nystagmus to move ipsilaterally
COWS: Cold Opposite, Warm Same.
Management
Stabilize patient and manage primary cause of illness.
Disposition
See Also
External Links
References
- ↑ Bardorf CM et al. Acquired Nystagmus Clinical Presentation. Updated My 13, 2016. http://emedicine.medscape.com/article/1199177-clinical?src=refgatesrc1#b4.