Assessing for Hyperventilation-induced Nystagmus

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Identifier Hyperventilation_voice_over
Title Assessing for Hyperventilation-induced Nystagmus
Alternative Title Video 6.12 Evaluating for hyperventilation-induced nystagmus from Neuro-Ophthalmology and Neuro-Otology Textbook
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 Hyperventilation
Description 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Hyperventilation induced nystagmus is tested by asking the patient to take quick deep breaths (~1/s) for 40-60 seconds. This decreases ICP and increases CSF pH. This can be helpful in diagnosing irritative conditions of the vestibular nerve, including an acoustic neuroma (see video, https://collections.lib.utah.edu/details?id=1213447) or neurovascular compression (vestibular paroxysmia). With these irritative disorders, nystagmus is usually in an excitatory pattern with contralateral slow phases and fast phases directed toward the side of the lesion (in contrast to a paretic or inhibitory pattern where the slow phase is ipsilesional). Hyperventilation can also accentuate the nystagmus of unilateral vestibular loss due to transient central decompensation. In cerebellar disease (e.g., spinocerebellar ataxia), a downbeat nystagmus may be provoked or accentuated due to pH-induced exacerbation of cerebellar Purkinje fiber calcium channel dysfunction. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: Hyperventilation induced nystagmus is tested by asking the patient to take quick deep breaths (~1/s) for 40-60 seconds. This decreases ICP and increases CSF pH. This can be helpful in diagnosing irritative conditions of the vestibular nerve, including a vestibular schwannoma or neurovascular compression (vestibular paroxysmia). With these irritative disorders, nystagmus is usually in an excitatory pattern with contralateral slow phases and fast phases directed toward the side of the lesion (in contrast to a paretic or inhibitory pattern where the slow phase is ipsilesional). Hyperventilation can also accentuate the nystagmus of unilateral vestibular loss due to transient central decompensation. In cerebellar disease (e.g., spinocerebellar ataxia), a downbeat nystagmus may be provoked or accentuated due to pH-induced exacerbation of cerebellar Purkinje fiber calcium channel dysfunction https://collections.lib.utah.edu/details?id=1307319. (Video and legend created with the assistance of Dr. Tony Brune and Justin Bosley)
Date 2018-01
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/s6pz98ht
Setname ehsl_novel_gold
ID 1307319
Reference URL https://collections.lib.utah.edu/ark:/87278/s6pz98ht
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