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Nystagmus: Diagnosis, Topographic Anatomical Localization and Therapy.
Klin Monbl Augenheilkd. 2021 Nov; 238(11):1186-1195.KM

Abstract

Nystagmus is defined as rhythmic, most often involuntary eye movements. It normally consists of a slow (pathological) drift of the eyes, followed by a fast central compensatory movement back to the primary position (refixation saccade). The direction, however, is reported according to the fast phase. The cardinal symptoms are, on the one hand, blurred vision, jumping images (oscillopsia), reduced visual acuity and, sometimes, double vision; many of these symptoms depend on the eye position. On the other hand, depending on the etiology, patients may suffer from the following symptoms: 1. permanent dizziness, postural imbalance, and gait disorder (typical of downbeat and upbeat nystagmus); 2. if the onset of symptoms is acute, the patient may experience spinning vertigo with a tendency to fall to one side (due to ischemia in the area of the brainstem or cerebellum with central fixation nystagmus or as acute unilateral vestibulopathy with spontaneous peripheral vestibular nystagmus); or 3. positional vertigo. There are two major categories: the first is spontaneous nystagmus, i.e., nystagmus which occurs in the primary position as upbeat or downbeat nystagmus; and the second includes various types of nystagmus which are induced or modified by certain factors. Examples are gaze-evoked nystagmus, head-shaking nystagmus, positional nystagmus, and hyperventilation-induced nystagmus. In addition, there are disorders similar to nystagmus, such as ocular flutter or opsoclonus. The most common central types of spontaneous nystagmus are downbeat and upbeat, infantile, pure torsional, pendular fixation, periodic alternating, and seesaw nystagmus. Many types of nystagmus allow a precise neuroanatomical localization: for instance, downbeat nystagmus, which is most often caused by a bilateral floccular lesion or dysfunction, or upbeat nystagmus, which is caused by a lesion in the midbrain or medulla. Examples of drug treatment are the use of 4-aminopyridine for downbeat and upbeat nystagmus, memantine or gabapentin for pendular fixation nystagmus, or baclofen for periodic alternating nystagmus. In this article we are focusing on nystagmus. In a second article we will focus on central ocular motor disorders, such as saccade or gaze palsy, internuclear ophthalmoplegia, and gaze-holding deficits. Therefore, these types of eye movements will not be described here in detail.

Authors+Show Affiliations

Neurologische Klinik der Ludwig-Maximilians-Universität München, Deutschland. Deutsches Schwindel- und Gleichgewichtszentrum der Ludwig-Maximilians-Universität München, Deutschland.Klinik für Neurologie, Universitätsspital Zürich, Schweiz.Neurologische Klinik der Universität zu Lübeck, Deutschland.

Pub Type(s)

Journal Article

Language

eng ger

PubMed ID

34784642

Citation

Strupp, Michael Leo, et al. "Nystagmus: Diagnosis, Topographic Anatomical Localization and Therapy." Klinische Monatsblatter Fur Augenheilkunde, vol. 238, no. 11, 2021, pp. 1186-1195.
Strupp ML, Straumann D, Helmchen C. Nystagmus: Diagnosis, Topographic Anatomical Localization and Therapy. Klin Monbl Augenheilkd. 2021;238(11):1186-1195.
Strupp, M. L., Straumann, D., & Helmchen, C. (2021). Nystagmus: Diagnosis, Topographic Anatomical Localization and Therapy. Klinische Monatsblatter Fur Augenheilkunde, 238(11), 1186-1195. https://doi.org/10.1055/a-1525-0030
Strupp ML, Straumann D, Helmchen C. Nystagmus: Diagnosis, Topographic Anatomical Localization and Therapy. Klin Monbl Augenheilkd. 2021;238(11):1186-1195. PubMed PMID: 34784642.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nystagmus: Diagnosis, Topographic Anatomical Localization and Therapy. AU - Strupp,Michael Leo, AU - Straumann,Dominik, AU - Helmchen,Christoph, Y1 - 2021/11/16/ PY - 2021/11/16/entrez PY - 2021/11/17/pubmed PY - 2021/11/19/medline SP - 1186 EP - 1195 JF - Klinische Monatsblatter fur Augenheilkunde JO - Klin Monbl Augenheilkd VL - 238 IS - 11 N2 - Nystagmus is defined as rhythmic, most often involuntary eye movements. It normally consists of a slow (pathological) drift of the eyes, followed by a fast central compensatory movement back to the primary position (refixation saccade). The direction, however, is reported according to the fast phase. The cardinal symptoms are, on the one hand, blurred vision, jumping images (oscillopsia), reduced visual acuity and, sometimes, double vision; many of these symptoms depend on the eye position. On the other hand, depending on the etiology, patients may suffer from the following symptoms: 1. permanent dizziness, postural imbalance, and gait disorder (typical of downbeat and upbeat nystagmus); 2. if the onset of symptoms is acute, the patient may experience spinning vertigo with a tendency to fall to one side (due to ischemia in the area of the brainstem or cerebellum with central fixation nystagmus or as acute unilateral vestibulopathy with spontaneous peripheral vestibular nystagmus); or 3. positional vertigo. There are two major categories: the first is spontaneous nystagmus, i.e., nystagmus which occurs in the primary position as upbeat or downbeat nystagmus; and the second includes various types of nystagmus which are induced or modified by certain factors. Examples are gaze-evoked nystagmus, head-shaking nystagmus, positional nystagmus, and hyperventilation-induced nystagmus. In addition, there are disorders similar to nystagmus, such as ocular flutter or opsoclonus. The most common central types of spontaneous nystagmus are downbeat and upbeat, infantile, pure torsional, pendular fixation, periodic alternating, and seesaw nystagmus. Many types of nystagmus allow a precise neuroanatomical localization: for instance, downbeat nystagmus, which is most often caused by a bilateral floccular lesion or dysfunction, or upbeat nystagmus, which is caused by a lesion in the midbrain or medulla. Examples of drug treatment are the use of 4-aminopyridine for downbeat and upbeat nystagmus, memantine or gabapentin for pendular fixation nystagmus, or baclofen for periodic alternating nystagmus. In this article we are focusing on nystagmus. In a second article we will focus on central ocular motor disorders, such as saccade or gaze palsy, internuclear ophthalmoplegia, and gaze-holding deficits. Therefore, these types of eye movements will not be described here in detail. SN - 1439-3999 UR - https://www.unboundmedicine.com/medline/citation/34784642/Nystagmus:_Diagnosis_Topographic_Anatomical_Localization_and_Therapy_ L2 - https://www.thieme-connect.com/DOI/DOI?10.1055/a-1525-0030 DB - PRIME DP - Unbound Medicine ER -