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906-4. Multiple Sclerosis. Eye Movements. Transient spontaneous primary position upbeat nystagmus with lid nystagmus Rapid bursts of horizontal square wave oscillations opening her eyes to fix on a target. Horizontal gaze evoked rotary (torsional) nystagmus

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906-4

Multiple Sclerosis


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Eye Movements

Transient spontaneous primary position upbeat nystagmus with lid nystagmus

Rapid bursts of horizontal square wave oscillations opening her eyes to fix on a target.

Horizontal gaze evoked rotary (torsional) nystagmus

(Rotation of the globe is best seen by observing conjunctival blood vessels).


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Eye Movements

Gaze evoked unsustained upbeat nystagmus

Saccadic pursuit except on downgaze

SaccadicDysmetria

Hypermetria left gaze to center.


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Clinical Features of Upbeat Nystagmus

Leigh JR and Zee DS. The Neurology of Eye Movements 4th Edition. Oxford University Press, New York 2006 with permission


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Upbeat Nystagmus

Localizes to the Caudal Medulla with lesion affecting the

Perihypoglossal group of nuclei including

nucleus intercalatus

nucleus of Roller

nucleus of pararaphales


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Upbeat Nystagmus

More rostral brainstem lesions may interrupt the ventral tegmental tract containing projections from the vestibular nuclei that receive inputs from the anterior semicircular canal

or

Involve the brachuim conjunctivum in the rostral pons and Medulla.


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Etiology of Upbeat Nystagmus

Leigh JR and Zee DS. The Neurology of Eye Movements 4th Edition. Oxford University Press, New York 2006 with permission


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Clinical Features of Torsional Nystagmus

Leigh JR and Zee DS. The Neurology of Eye Movements 4th Edition. Oxford University Press, New York 2006 with permission


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Neuroimaging

Figure 1 Series of sagittal and axial FLAIR scans show classical calloseptal and deep periventricular foci of increased signal intensity surrounding cavatating areas in this patient with long standing MS


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Neuroimaging

Note a small foci in the pons

Note perpendicular orientation

Towards the ventricle classic

for“Dawson fingers”

Courtesy of Anne Osborn,M.D.


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References

Leigh RJ, Zee DS. Diagnosis of Nystagmus and Saccadic Intrusion. Chp 10;475-558. In: The Neurology of Eye Movements, 4th Edition, Oxford University Press, New York, 2006.

Tilikete C, Koene A, Nighoghossian N., Vighetto A, Pélisson . Saccadic lateropulsion in Wallenberg syndrome: a window to access cerebellar control of saccades? Exp Brain Res 2006; 174(3);555-65.


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References

Tilikete C. Hermier M. Pelisson D, Vighetto A. Saccadic lateropulsion and primary position upbeat nystagmus: disorders of caudal medulla. Ann Neurol 2002; 52:658-662.



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