Nystagmus

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  • Nystagmus

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

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