Acquired Nystagmus Workup

Updated: Oct 17, 2018
  • Author: Christopher M Bardorf, MD, MS; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Workup

Imaging Studies

Any patient who develops nystagmus without an identifiable cause (eg, Ménière disease, drug toxicity) or with localizing neurologic deficits should undergo neuroimaging. A complete history and neuro-ophthalmic examination are crucial to localizing an intracranial disorder. Communication with the neuroradiologist regarding such localization is important in ensuring that regions of the brain suggestive of a disorder are imaged adequately.

Central vestibular forms of nystagmus are always pathologic and deserve a thorough evaluation. MRI is the preferred method of neuroimaging.

Infantile nystagmus typically manifests in the first six months of life, and the oscillations are usually pendular rather than jerk. Visual loss, if present, is stable and not progressive. Any child who develops nystagmus in early childhood should be evaluated carefully. The presence of a pale optic disk a history of progressive visual loss or unilateral vertical nystagmus should suggest that the nystagmus is acquired and possibly due to a neoplasm involving the visual system. Such patients require neuroimaging with MRI.

Optic chiasm or third ventricle gliomas can cause a condition that mimics spasmus nutans. All children with spasmus nutans should undergo a complete neuro-ophthalmic examination. Signs suggestive of a neoplastic etiology include decreased visual acuity, relative afferent pupillary defect, optic disc pallor, failure to thrive, age of onset before 12 months, and vertical or seesaw nystagmus. All such children should undergo an MRI. If the decision is made to delay MRI in children without neurologic deficit, they should be observed closely for onset of such neurologic deficits.

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Other Tests

Electronystagmographs record eye muscle contractions to evaluate the direction and velocity of nystagmus. It may be used to evaluate low-amplitude nystagmus that is difficult to discern on examination. This study can help determine the type and velocity of the nystagmus, which is important in directing therapy.

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