Nystagmus: Difference between revisions
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==Background== | ==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 locked when the head is in motion | *The semicircular canals of the vestibules and the extraocular muscles of the eye function together physiologically to help control gaze locked when the head is in motion | ||
*Nystagmus is an aberration in this stabilization of the ocular muscles when in motion | *Nystagmus is an aberration in this stabilization of the ocular muscles when in motion | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
===Congenital Nystagmus=== | ===Congenital Nystagmus=== | ||
* Optic | *Optic nerve hypoplasia | ||
* Macular | *Macular disease | ||
*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]], [[MDMA]] | |||
*[[Marijuana]] | |||
*[[Lithium]] | |||
*[[Phenytoin]], [[fosphenytoin]], [[carbamazepine]], [[oxcarbazepine]], [[lacosamide]], [[gabapentin]] | |||
*[[Salicylates]], [[NSAID toxicity]] | |||
==Evaluation== | ==Evaluation== | ||
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==Management== | ==Management== | ||
Stabilize patient and manage primary | Stabilize patient and manage primary cause of illness. | ||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Focal neurologic deficits]] | |||
==External Links== | ==External Links== | ||
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<references/> | <references/> | ||
[[Category:Symptoms]] | [[Category:Symptoms]] [[Category:Neurology]] | ||
Revision as of 01:44, 26 February 2017
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 locked when the head is in motion
- Nystagmus is an aberration in this stabilization of the ocular muscles when 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:
- Ketamine, Phencyclidine
- Amphetamines, MDMA
- Marijuana
- Lithium
- Phenytoin, fosphenytoin, carbamazepine, oxcarbazepine, lacosamide, gabapentin
- Salicylates, NSAID toxicity
Evaluation
"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.