Acquired Pendular And Developmental Nystagmus

Front 1

How common is acquired pendular nystagmus?

Back 1

One of the more common types

Front 2

Is there a fast phase with acquired pendular nystagmus?

Back 2

no

Front 3

What are the three trajectories of acquired pendular nystagmus?

Back 3

horizontal, vertical, and oblique

Front 4

How many trajectories might a patient's nystagmus take?

Back 4

Can be all three

Front 5

What determines trajectory?

Back 5

Phase relationship between the different components.

Front 6

If horizontal and vertical components are in phase then the trajectory with be________.

Back 6

oblique

Front 7

If the horizontal and vertical components are 180 degrees out of phase then the trajectory will be __________.

Back 7

elliptical

Front 8

If the horizontal and vertical components are 90 degrees out of phase then the trajectory will be __________.

Back 8

circular

Front 9

Is acquired pendular nystagmus conjugate, diconjugate, or disjunctive?

Back 9

Can be any

Front 10

What is the common presentation?

Back 10

disconjugate, disjunctive, with equal frequency

OR monocular

Front 11

What is common about the frequency in binocular acquired pendular nystagmus?

Back 11

usually the same in both eyes

Front 12

Where is the interruption with acquired pendular nystagmus?

Back 12

In the circuitry between the neural integrators in the brainstem (MVN, NPH, and INC) and the cerebellum.

Front 13

What are the 4 main categories of causes of acquired pendular nystagmus?

Back 13

1. Vision Loss
2. Demyelination
3. Oculopalatal Tremor
4. Whipple's Disease (oculomasticatory myorhythmia)

Front 14

What are 3 other categories of causes of acquired pendular nystagmus?

Back 14

1. Spasmus nutans
2. Acute brainstem stroke
3. Spinocerebellar degeneration

Front 15

Acquired pendular nystagmus due to vision loss most often occurs with what?

Back 15

Optic nerve disease (in one or both eyes)

Front 16

Which type of APN can be monocular?

Back 16

When it is due to vision loss.

Front 17

What might occur if there is APN in both eyes due to optic nerve disease?

Back 17

The eye with worse VAs (worse disease) has worse nystagmus.

Front 18

What is it called when the APN is worse in the eye with worse ON disease and therefore worse VAs?

Back 18

Heinmann-Bielschowsky Phenomenon

Front 19

APN due to vision loss (an ON disease) is characterized by what type of waveform?

Back 19

vertical, low frequency with subtle horizontal jerks

Front 20

Besides ON disease, what can cause APN due to vision loss?

Back 20

Leber's "Congenital" Amaurosis
Rod-Cone Dystrophy
Severe Amblyopia

Front 21

How would you describe the APN caused by amblyopia due to deprivation as a young child?

This nystagmus is also called what?

Back 21

Poor fixations (visuoscopy)
Low amplitude
Irregular frequency
Slow velocity

Slow drifts

Front 22

Besides amblyopic patients who else will have slow drifts?

Back 22

Patients with:
-macular holes
-solar retinopathy

Front 23

What is the most common cause of APn due to myelination?

Back 23

MS

Front 24

What else might you expect to see with MS?

Back 24

internuclear ophthalmoplegia

Front 25

How would you treat a patient with APN and INO due to MS? (drug)

Back 25

Memantine

Front 26

Besides MS what other demyelinating disease can cause APN?

Back 26

Pelizaeus-Merzbacher disease
Cockayne's syndrome
Peroxisomal assembly disorders
Toluene abuse

Front 27

What is memantine

Back 27

low-to-moderate
uncompetitive NMDA receptor agonist

Front 28

What does memantine do for APN due to MS?

Back 28

suppresses it

Front 29

What are some other drug options besides memantine for APN due to MS?

Back 29

gabapentin
clonazepam
valproate
scopolamine

Front 30

What is the underlying cause of APN due to oculopalatal tremor?

Back 30

Brainstem stroke to the red nucleus

Front 31

Which drug is the Tx of choice for patients with APN due to oculopalatal tremor?

Back 31

Gabapentin

Front 32

Why is gabapentin the DOC for APN due to oculpalatal tremor?

Back 32

Not sure

Inhibitory neurotransmitter GABA is mimiced by gabapentin.

Front 33

What is gabapentin usually used as?

Back 33

Anticonvulsant

Front 34

What type of propeties does Gabapentin have?

Back 34

GABA-ergic

Front 35

What is a significant side effect of gabapentin?

Back 35

Increased ataxia

Front 36

What 2 things are caused by Whipple's disease?

Back 36

APN and oculomasticatory myorhythmia

Front 37

How common is Whipple's disease?

Back 37

Rare

Front 38

What causes Whipple's disease?

Back 38

Infection by the bacteria Tropheryma whippelii (intestinal)

Front 39

The sole symptom of Whipple's disease is what

Signs (4)?

Back 39

The CNS involvement

1. Altered mentation
2. Polydipsia
3. Hyperphagia
4. Myoclonus

Front 40

Describe the APN caused by Whipple's disease?

Back 40

Convergence-divergence (occasionally vertical) oscillations

Frequency: 1Hz

Pathognomonic for Whipple's

Persists during sleep

Front 41

What about amplitude with APN?

Back 41

Can differ between eyes or even be monocular

Front 42

What can sometimes momentarily suppress oscillations in APN?

Back 42

a saccade

Front 43

Frequency APN with demyelinating disease?

Back 43

2-8 Hz

Front 44

What type of component might you have associated with APN due to demyelinating disease?

Back 44

an upbeat component

Front 45

Which type of nystagmus, APN or congenital PN, has a more regular waveform and what is it?

Back 45

APN

sinusoidal

Front 46

For which type of nystagmus, APN or CPN, is dissociation between the eyes more rare?

Back 46

congenitcal pendular nystagmus

Front 47

Which direction does APN go?

Back 47

Horizontal, Vertical, or Torsional

Front 48

What direction does congenital PN go?

Back 48

Horizontal and uniplanar
(RARELY vertical or torsional)

Front 49

For which type of pendular nystagmus, acquired or congenital, will you see an OKN reversal?

Back 49

Congenital

Front 50

Will a patient with congenital pendular nystagmus experience oscillopsia?

APN?

Back 50

No

Yes

Front 51

What are the 3 types of Developmental Nystagmus discussed in Kundart's lecture?

Back 51

1. Infantile
2. Latent
3. Spasmus nutans

Front 52

What is another name for Latent nystagmus?

Back 52

Fusional maldevelopment nystamus syndrome

Front 53

What are two most common features of infantile nystagmus (usually)?

Back 53

Horizontal
Conjugate

Front 54

What 2 things should you look for here to Dx?

Back 54

A null point (dampening zone)
Reversal of OKN response

Front 55

What can cause increased frequency of the nystagmus?

What might make it better?

Back 55

attempted fixation

dark or on convergence (sometimes also it helps to just ask the patient to try to keep their eyes still rather than asking them to fixate on something)

Front 56

What does uniplanar mean in describing this type of nystagmus?

Back 56

It stays horizontal in all positions of gaze

Front 57

What are the only 2 other types of nystagmus that are uniplanar?

Back 57

1. Peripheral vestibular
2. PAN

Front 58

What does SLOFUN+ stand for?

Back 58

S: symptoms (none)
L: Latency (+, beats away from occluder)
O: OKN (reversal or double fast)
F: Fixation (worse when trying to fix)
U: Upgaze (stays horizontal, uniplanar)
N: Null Point (R, L, or Conv)
+: Gone with lid closure or sleep

Front 59

What is the management plan for congenital nystagmus?

Back 59

Correct RE
BO possibly for dampening by conv.
Yoked prism with bases toward head turn.
Surgery for positioning null point.

Front 60

What is the surgery for positioning the null point called?

Back 60

Kestenbaum procedure

Front 61

What should you look for as far as RE goes with patients with congenital nystagmus?

Back 61

A lot of WTR cylinder

Front 62

Can you see latent nystagmus binocularly?

Back 62

No

Front 63

When does latent nystagmus become manifest?

Back 63

With occlusion of either eye

Front 64

What happens to the direction of the nystagmus when you occlude each of the eyes?

Back 64

It changes from one eye to the other

Front 65

How can you take VAs or refract this patient?

Back 65

Use blur instead of occlusion

Front 66

What else is also present in most cases?

Back 66

Infantile esotropia

Front 67

What 3 other conditions are commonly associated with latent nystagmus?

Back 67

Down syndrome
DVD - dissociated (double) vertical deviation (see video in Wong)
Lack of steropsis (binocular vision)

Front 68

What way does a latent nystagmus beat?

Back 68

Away from the covered eye

Front 69

What other directions besides horizontal might be present with latent nystagmus?

Back 69

A torsional component
A vertical upbeating component

Front 70

What might be off about smooth pursuits with latent nystagmus?

Back 70

Asymmetric

Front 71

With associated DVD in latent nystagmus (dissociated vertical deviation) what happens when an eye is covered?

Back 71

Eye under cover goes up

Front 72

At what age does spasmus nutans usually present?

Back 72

age 1

Front 73

How long does spasmus nutans usually last? How long CAN it last?

Back 73

1-2 years

more than 8 years

Front 74

What type of waveform do you see with spasmus nutans?

Back 74

pendular with intermittent, small, fast horizontal movements

Front 75

In spasmus nutans the intermittent small horizontal fast movements are worse in which eye?

Back 75

The abducting eye

Front 76

Does spasmus nutans get worse or better with convergence?

Back 76

worse

Front 77

What is the Spasmus nutans triad?

Back 77

1. Nystagmus
2. Head nodding
3. Abnormal head position

Front 78

Is spasmus nutans usually conjugate or disconjugate or disjunctive?

Back 78

disconjugate and disjunctive

Front 79

How would you describe the head movements AW spasmus nutans?

Back 79

irregular with horizontal and vertical components

Front 80

What else might you find in regards to the eyes?

Back 80

strabismus
amblyopia

Front 81

What could you do to rule out structural lesions in the visual pathway with spasmus nutans?

Back 81

A normal ophthalmoscopic exam
normal MRI or CT

Front 82

How does spasmus nutans resolve?

Back 82

Spontaneous remission

Front 83

What are 3 miscellaneous Tx discussed in class for nystagmus?

Back 83

1. Botox
2. Static Optics (prism)
3. Dynamic optics (CL)

Front 84

What does Botox do?

Back 84

Paralyzes muscle for a period of a few months

Front 85

What kind of prism would you use for a patient that has nystagmus that dampens with convergence?

Back 85

BO

Front 86

To correct a head tilt where should you place the bases of yoked prisms?

Will this also straighten the eyes?

Back 86

Toward the head tilt

No

Front 87

What is the problem with spectacle correction for patients with nystagmus?

Back 87

The optical centers of the lenses don't move with the eyes.

Front 88

Why might CL be better than specs for correcting patients with nystagmus?

Back 88

The optical centers do move with the eye.