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Nystagmus

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  • Transcript

    • 1. NYSTAGMUS Neil Bailie ENT Postgraduate Class 18/05/01
    • 2. Definition
      • ‘ nmstagmos ’ (Greek) the head nodding seen with alcohol or drowsiness
      • Nystagmus may be defined as:
      • “ a periodic rhythmical ocular oscillation that is initiated by a slow phase(drift)”
    • 3. Control of Gaze
      • Gaze Stabilisation system
      • 2) Gaze alignment system
    • 4. Gaze Stabilisation System
      • Compensates for self-motion stabilising visual world on the retina
      • - Vestibulo-ocular system
      • - Optokinetic System
    • 5. Gaze Alignment System
      • Keeps object of interest within the visual world centred on fovea
      • -Saccades
      • -Smooth pursuit
    • 6. Classification of Nystagmus
      • Pendular Vs Jerk
      • Physiological Vs Pathological
      • Congenital Vs Acquired
      • Peripheral Vs Central
      • Spontaneous Vs Gaze-evoked
    • 7. Pendular Nystagmus
      • Slow oscillations with approximately equal velocity and amplitude in both directions
      • May be horizontal, vertical or rotatory
      • Commonly congenital or caused by poor visual fixation
      • Rarely occurs in ‘neurological’ disease
    • 8. Jerk Nystagmus
      • Slow phase in one direction followed by a rapid phase in the opposite direction
      • Slow phase – pathological
      • Rapid phase – corrective response
      • Named after the direction of the fast phase
    • 9. Physiological Nystagmus
      • ‘End-point’ nystagmus
      • Optokinetic nystagmus
      • Vestibular Caloric – ‘COWS’
    • 10. Pathological Nystagmus
      • Labyrinthine nystagmus
      • Central Nystagmus
      • Positional Nystagmus
      • Disconjugate Nystagmus
    • 11. Labyrinthine Nystagmus
      • Horizontal-rotatory or horizontal jerk nystagmus
      • Unidirectional with fast phase away from affected side
      • Intensity maximal looking in direction of fast phase (Alexander’s Law)
      • Tend to fall away from direction of fast phase
    • 12. Central Nystagmus
    • 13. Positional Nystagmus
      • Peripheral BPPV
      • Central
      • Atypical
    • 14. Disconjugate Nystagmus
      • Ataxic Nystagmus
      • See-Saw Nystagmus
    • 15. Clinical Assessment
      • Ask patient to fix and follow on your finger (about 1m away)
      • Move slowly to 12, 3, 6 and 9 o’clock waiting 5 seconds at each position
      • Do not move more than 30 degrees from midline
      • Nystagmus must be sustained for more than a few beats to be significant

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