Periodic Alternating Nystagmus Due to a Chiari Malformation

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Identifier Periodic_alternating_nystagmus_due_to_a_Chiari_malformation
Title Periodic Alternating Nystagmus Due to a Chiari Malformation
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
Description This patient first experienced oscillopsia 12 months prior to this video. Three months after the onset of symptoms, she was seen by neuro-ophthalmology and found to have a spontaneous, unidirectional left-beating nystagmus (that did not reverse) in addition to saccadic smooth pursuit. Oscillopsia worsened over subsequent months. At the time of this video, in addition to having gaze evoked nystagmus, she also had spontaneous horizontal nystagmus. When this nystagmus was observed for 90 to 120 seconds, it would slow down, stop, and then reverse. For example, initially seen in this video is spontaneous right beating nystagmus. Over the course of 60 to 90 seconds, it slows down until it reaches a silent or null period. Then it reverses to left-beating nystagmus and intensifies. This pattern of reversing horizontal nystagmus with an intervening null period is highly suggestive of periodic alternating nystagmus. The patient underwent MRI which demonstrated a Chiari malformation. Upon review of her MRI, there was clear tonsillar (paraflocculus) herniation as well as distortion of the nodulus. Of note, PAN typically localizes to the cerebellar nodulus and uvula. Given the severity of her oscillopsia, baclofen therapy was initiated prior to neurosurgical consultation. The patient was seen virtually 4 days after the recording of this video, and had experienced dramatic subjective and objective improvement (no video available, but PAN could not be appreciated via telemedicine). Although neurosurgery was recommended, she is doing so well symptomatically that she has not decided to pursue surgery at this time.
Date 2022-09
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/s6j64arb
File Name Palato-ocular_synchrony_in_oculopalatal_tremor.mp4
Setname ehsl_novel_gold
ID 2060053
Reference URL https://collections.lib.utah.edu/ark:/87278/s6j64arb
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