Pendular, Gaze-Evoked and Abducting Nystagmus in MS

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Identifier Pendular_gaze-evoked_and_abducting_nystagmus_in_MS
Title Pendular, Gaze-Evoked and Abducting Nystagmus in MS
Creator Tony Brune, DO; Daniel R. Gold, DO
Affiliation (TB) Department of Neurology, The Johns Hopkins School of Medicine, Baltimore, Maryland; (DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
Subject Jerk Nystagmus; INO; Pendular Nystagmus; Abducting Nystagmus; Gaze-Evoked Nystagmus; Cerebellar OMS
Description This is a 40-year-old woman with a history of multiple sclerosis who presented for oscillopsia. On examination, she had bilateral internuclear ophthalmoplegia (INO-adduction lag OU and abducting nystagmus OU), with a corresponding exotropia that increased in right and left gaze. She also had horizontal pendular nystagmus, most notable in primary gaze and with a brief pause with blinking and after saccades (typical findings with pendular nystagmus). There was evidence of bilateral optic neuropathy with dyschromatopsia, pallor, and 20/100 best corrected acuities OU, subnormal in part due to optic nerve disease and in part due to her nystagmus. While delay in visual inputs (due to optic nerve involvement) is one theory for pendular nystagmus in MS (could explain why nystagmus is usually more prominent in the worse-seeing eye), in most patients, instability of the neural integrators is likely to play a significant role in the genesis of pendular nystagmus. This patient also had gaze-evoked nystagmus (GEN) vertically and horizontally, which is related to dysfunction of the neural integrators (interstitial nucleus of Cajal [INC] for vertical/torsional movements; nucleus prepositus hypoglossi and medial vestibular nucleus for horizontal movements; cerebellum [especially flocculus/paraflocculus] or its connections when GEN is in all directions). Due to the superimposed horizontal pendular and abducting nystagmus, her horizontal GEN was best appreciated in the adducting eye. Vertical GEN (especially upbeat in upgaze) is common with bilateral INOs, either related to damage involving vertical gaze holding pathways that travel through the medial longitudinal fasciculi, or related to involvement of the adjacent paramedian tracts, which relay eye position signals from INC to cerebellar flocculus. Further reading: Nerrant and Tilikete. Ocular motor manifestations of multiple sclerosis. Journal of Neuro-Ophthalmology 2017;37:332-340.
Date 2018-04
Language eng
Format video/mp4
Type Image/MovingImage
Collection Neuro-Ophthalmology Virtual Education Library: Dan Gold Collection: https://novel.utah.edu/Gold/
Publisher North American Neuro-Ophthalmology Society
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management Copyright 2016. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s6rr61n4
Setname ehsl_novel_gold
ID 1316080
Reference URL https://collections.lib.utah.edu/ark:/87278/s6rr61n4
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