Downbeat Nystagmus

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Identifier Downbeat_Nystagmus
Title Downbeat Nystagmus
Alternative Title Video 5.11 Downbeat nystagmus causing severe oscillopsia from Neuro-Ophthalmology and Neuro-Otology Textbook
Creator Daniel R. Gold, DO
Affiliation (DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
Subject Downbeat Nystagmus; OMS Cerebellar; Jerk Nystagmus; Vestibular Nystagmus
Description 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 40-year-old man with 2 years of progressive ataxia and oscillopsia. On examination, he had downbeat nystagmus (DBN), an ocular motor finding that is usually (but not always) associated with flocculus/paraflocculus dysfunction, which causes overaction of the anterior canal (upward or anti-gravity) pathways relative to posterior canal (downward or gravity) pathways. This results in a continuous slow upward phase and subsequent fast downward phase, causing the DBN. In his case, there was a history of a testicular seminoma (s/p resection) several years prior to presentation, and during the initial work-up he was found to have a CSF lymphocytic pleocytosis, but unrevealing paraneoplastic panel, brain MRI and body PET/CT. There was no clear response to steroids and IVIG, and for his DBN, trials of 4-aminopyridine and chlorzoxazone were ineffective. After 2 years, significant cerebellar atrophy was apparent on his MRI. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: This patient experienced progressive ataxia and oscillopsia over two years of unknown etiology. Unfortunately, trials of 4-aminopyridine, clonazepam, baclofen, and chlorzoxazone were ineffective. After 2 years, significant cerebellar atrophy was apparent on his MRI. https://collections.lib.utah.edu/ark:/87278/s6wq42f0
Date 2018-02
Language eng
Format video/mp4
Type Image/MovingImage
Collection Neuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
Publisher North American Neuro-Ophthalmology Society
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890
Rights Management Copyright 2016. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s6wq42f0
Setname ehsl_novel_gold
ID 1295176
Reference URL https://collections.lib.utah.edu/ark:/87278/s6wq42f0
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