NYSTAGMUS

Ask the Following Questions:

1. Is the nystagmus pendular? Pendular nystagmus without a fast or slow component suggests ocular nystagmus due to albinism, partial blindness, or other ocular disorders.
2. Is it intermittent or fatigable? Intermittent or fatigable nystagmus suggests otologic disorders such as acoustic neuroma, Ménière's disease, vestibular neuronitis, and acute labyrinthitis.
3. Is there associated tinnitus or deafness? The presence of nystagmus with tinnitus or deafness also suggests otologic disorders such as acoustic neuroma, Ménière's disease, or cholesteatoma. If there are long tract signs, multiple sclerosis and brain stem tumors must be considered.
4. Is the nystagmus brought on by change of position? Nystagmus brought on by certain changes of position suggests benign positional vertigo. However, this also may be found in post-traumatic labyrinthitis and postconcussion syndrome.
5. Are there associated long tract signs? The presence of long tract signs suggests multiple sclerosis, basilar artery insufficiency, syringomyelia, and Friedreich's ataxia. Certain brain stem tumors may also be associated with long tract signs.

DIAGNOSTIC WORKUP

The basic diagnostic workup includes visual acuity, visual fields, audiogram, caloric testing, and x-rays of the skull, mastoids, and petrous bones. If these are negative or indefinite, a CT scan or MRI of the brain will be necessary. A spinal fluid analysis will help diagnose central nervous system lues and multiple sclerosis. A BSEP or VEP study may be needed to diagnose multiple sclerosis. The help of a neurologic specialist should be sought before ordering expensive diagnostic tests. Cisternography, tomography, and vertebral basilar angiography are occasionally necessary to establish the diagnosis. Magnetic resonance angiography is an excellent noninvasive means of visualizing the vertebral-basilar circulation.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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