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Upbeat Nystagmus






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917-5. Upbeat Nystagmus. Eye Movements. Upbeat nystagmus in primary gaze Horizontal gaze evoked nystagmus left > right No nystagmus on downgaze Saccadic pursuit in all directions. Square wave jerks. Dysmetria. Marked saccadic hypermetria
Upbeat Nystagmus

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Slide 1

917-5

Upbeat Nystagmus

Slide 2

Eye Movements

Upbeat nystagmus in primary gaze

Horizontal gaze evoked nystagmus left > right

No nystagmus on downgaze

Saccadic pursuit in all directions.

Square wave jerks

Slide 3

Dysmetria

Marked saccadic hypermetria

Right gaze to center overshoot (hypermetria) taking the eyes almost fully to the left

Left gaze to center (hypermetria) taking the eyes almost fully to the right

Upgaze to center hypermetria

Downgaze to center hypermetria

Slide 4

Clinical Features of Upbeat Nystagmus

Present in primary gaze usually increases on upgaze

Slow phases may have linear-, increasing-, or decreasing-velocity waveforms

Poorly suppressed by visual fixation of a distant target

Slide 5

Clinical Features of Upbeat Nystagmus

Convergence may increase, suppress or convert to downbeat nystagmus

Associated with abnormal vertical vestibular and smooth-pursuit responses, and saccadic intrusions (square-wave jerks) that produce a bow-tie nystagmus

Slide 6

Upbeat Nystagmus

Localizes to the Caudal Medulla with the lesion affecting the perihypoglossal group of nuclei including:

nucleus intercalatus

nucleus of Roller

nucleus of pararaphales

Slide 7

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.

Slide 8

Etiology of Upbeat Nystagmus

Infarction of medulla or cerebellum and superior cerebellar peduncle

Wernicke’s encephalopathy

Multiple sclerosis

Tumors of the medulla, cerebellum or midbrain

Cerebellar degeneration or anomalies

Slide 9

Etiology of Upbeat Nystagmus

Brainstem encephalitis

Creutzfeldt-Jacob disease

Bechet’s syndrome

Meningitis

Thalamic arteriovenous malformation

Transient finding in infants

Slide 10

Clinical Features of Torsional Nystagmus

Torsional jerk nystagmus (minimal vertical or horizontal components) present with eye close to central position.

Slow phases may have linear-, increasing-, or decreasing-velocity waveforms

Poorly suppressed by visual fixation of a distant target

Exacerbated by changes in head position or vigorous head shaking

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

Slide 11

Clinical Features of Torsional Nystagmus

May be suppressed by convergence

Often occurs in association with ocular tilt reaction or unilateral internuclear ophthalmoplegia

May be precipitated or modulated by vertical smooth pursuit movements.

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

Slide 12

Etiology of Torsional Nystagmus

Syringobulbia, with or without syringomyelia

Arnold-Chiari malformation

Brainstem stroke (e.g., Wallenberg’s syndrome)

Arteriovenous malformation in the brainstem or middle cerebellar peduncle

*Often occurs in association with the ocular tilt reaction and unilateral internuclear ophthalmoplegia.

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

Slide 13

Etiology of Torsional Nystagmus

Brainstem tumor

Multiple sclerosis

Oculopalatal tremor (“myoclonus”)

Head trauma

Congenital

Slide 14

References

The Neurology of Eye Movements, 4th Edition, Oxford University Press, New York, 2006.

Tilikete C. Koene A. Nighoghossian N, Vighetto A, Pelisson. Saccadic lateropulsion in Wallenberg syndrome: a window to access cerebellar control of saccades? Exp Brain Res 2006;174(3):555-565.

Slide 15

Tilikete C, Hermier M, Pelisson D, Vighetto A. Saccadic lateropulsion and upbeat nystagmus: disorders of caudal medulla. Ann Neurol. 2002 Nov;52(5):658-62.

Slide 16

http://library.med.utah.edu/NOVEL


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