Term
Medulla Abnormalities...cause what?
4 Associated conditions? |
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Definition
General shift toward one side. Upbeat nystag.
Lateralpulsion
Wallenberg
Oculopalatal Tremor
Medulary Lesion |
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Term
Pons Abnormalities...cause what?
4 Associated conditions |
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Definition
Eyes can't cross the midline when looking at the side of the lesion. (horiontal gaze palsy)
PPRF (Parapontine Reticular Formation)
Abducens Nuclear Lesion
INO lesion - in the MLF
Combined lesions (1.5 syndrome) |
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Term
Cerebellum Abnormalities...cause what?
Which 4 parts of the cerebellum have issues
5 conditions |
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Definition
Saccadic over/undershoot. Jerky movments. Downbeat nystag.
Dorsal Vermis
Fastigial Nucleus
Flocculus & Paraflocculus
Nodulus and Uvular
Lateropulsion/Wallenberg (also in Medulla).
Cerebellar infarction.
Congentital malf- Arnold Chiari, Dandy Walker, Walker Warburg |
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Term
Midbrain Abnormalities...cause what?
Associated conditions (midbrain only)
Other 6 conditions (that involve other parts of the brain too) |
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Definition
Vertical probs. Fixation instability. INO (eso)
Basilar Syndrome, Dorsal Midbrain, Intersitial nucleus of Cajal, Lesions
PSP, Whipple, MS, Wernicke, Alzhimers, AIDS |
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Term
| Cerebrum Abnormalities...cause what in which lobe? |
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Definition
Frontal Lobe- inaccurate sacades
Parietal- one sided and innatention issues
Occipital-Local (MST,V3) and Global motion (MT) pursuits
Temporal- Midline shifted (also in Interstitial Nucleus of Cajal, midbrain) |
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Term
Downbeat Nystagmus
(a type of central vestibular nystag) |
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Definition
Drift up, beat down
Worse in downgaze
Posterior Canal, head pitch
Arnold Chiari
Cerebellum prob
MS
Meds, idiopathic
Treat: Maybe: BO prism BACLOFEN, Acetazolamide |
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Term
Upbeat Nystagmus
(a type of central vestibular nystag) |
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Definition
Drifts Down, Beats up. Upgaze makes worse. Abnormal Pursuits.
Anterior Canal, or Superior Cerebellar Peduncle, or Pons/Brainstem junction.
Cause: Cerebellar degeneration or stroke, MS, Infectious or a tumor
Treat: harder than downgaze:
4-aminopyridine, Clonazepam, BI or BO |
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Term
Torsional Nystag
(a type of central vestibular nystag) |
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Definition
Beats away from the lesion.
Why: Anterior and Posterior Canal Projections
Cause: STROKE, MS, Arnold chiari, Angioma
Treatment: Underlying disorder,
mabye Gabapentin, Baclofen clonezapam. |
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Term
Seesaw
(a type of central vestibular nystag) |
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Definition
One eye intorts and elevates, the other extorts and depresses.
(Hemi-seesaw, associated w/ position and otoliths)
Location: INC and Chiasm
Cause: Pituitary Adenoma, TIA, Trauma
Treatment: BACLOFEN, Clonazapam, Gabapentin, Alcohol? |
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Term
Periodic Alternating Nystag (PAN)
(a type of central vestibular nystag) |
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Definition
Beats to one side, then after a few seconds beats to the other side.
Lesion in Flocculus and Nodulus. (they tend to have WTR cyl)
Cause: MS!!, Albinism, Arnold Chiari.
Treatment: BO prism, convergence may dampen. |
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Term
Positional Nystag
(a type of central vestibular nystag) |
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Definition
Position evoked (pseudo -BPPV)
4 types |
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Term
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Definition
Gaze evoked is most common: move eye into lateral gaze, and it beats away from center.
Treatment: Alcohol, anticonvulsants/depressants.
AND if moved toward primary gaze, beat the opposite way. (CENTRIPITAL/ REBOUND saccades).
OR Dissociated- one eye goes "come on! come on!) |
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Term
| Aquired Pendular Nystagmus (APN) |
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Definition
NO FAST PHASE. Looks like a general eye wobble. Horizontal/vertical/the works.
Leber's Rod-cone, MS, INO
Treat: MEMANTINE!! Clonazepam, valproate ,scopolamine |
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Term
| Developmental Nystag (Infantile) |
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Definition
Different manifestations
Horizontal and conjugate jerk, patient tilted to one side. Maybe PAN. Backwards OKN! Beats away from occluder
WTR Astigmatism (b/c of PAN). Associated w/ Albinism (macular pigment prob)
Treat: w/ yoked (base in direction of head turn). Or BO. Or Kestenbaum |
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Term
Latent Nystagmus (Fusional maldevelopment)
(Developemental) |
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Definition
Cover right eye and left eye will beat left. Cover left eye and right eye will beat right.
**ESO tropia! and DVD!!
Take VAs by fogging.
Treatment:
Resection of MR maybe (not emphasized) |
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Term
Spasmus Nutans
(Developmental Nystagmus) |
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Definition
Sontaneously beginning and ending (a few years later). Fast pendular eye movements. Bob their head.
Rule out tumor w/ MRI |
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Term
| Aquired Vs. Congenital Pendular Nystagmus |
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Definition
Aquired: sinusiodal curve pattern, frequently dissociated, can be vertical and torisional, OKN is normal, Frequently have oscillopsia.
Congenital: irregualar pattern, eyes move together, ONLY HORIZONTAL, OKN reversal, no oscillopsia. |
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Term
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Definition
Use for: EOM overreactions, palsies, nystag
Conditions: MS, stroke, myoclonus nystag.
Lasts months, works best w/ aquired nystag |
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Term
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Definition
BO- Used to induce convergence dampening (Dbeat, Upbeat, PAN!!)
Yoked- to image shift (infantile PAN) |
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Term
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Definition
Tightens the reigns. Use when they have a head turn.
Infantile/Latent onset Nystag (congenital)
Doesn't dampen nystag. Used on Torticolis |
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Term
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Definition
| Cut all the muscles, put them back and hope the nystag goes away. |
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Term
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Definition
Downbeat nystag
Arnold Chiari
Gaze-evoked Meneirs
Normally used for: Glaucoma, Meneirs, Pseudotumor ceribri, Arnold chiari
SULFA!!! |
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Term
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Definition
Downbeat nystag
K channel blocker- MS, bird pesticide |
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Term
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Definition
| MOST COMMON MED FOR NYSTAG. Upbeat, downbeat, Seesaw, PAN, Torisonal |
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Term
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Definition
SeeSaw (Chiasmal)
APN
maybe upbeat and torisonal.
Normal Use: Seizures, panic, anxiety. |
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Term
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Definition
APN!
maybe Seesaw, torisional, Oculopalatal tremor
Used for Epilepsy, neruopathic pain, marketed for suicide but not good. |
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Term
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Definition
APN (especially due to MS)
Might protect ganglion cells.
Crosses bbbarier
Alzheimer's |
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Term
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Definition
APN
Used normally for Parkinsons, GI spasm, Truth serum |
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Term
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Definition
APN (but Memantine is drug of choice for that)
Normally for crazies and epileptics. Don't take when preggo. |
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Term
| Treatment for nystag: Skills vision therapy |
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Definition
| Enhance BV. Anti-suppression. Therefore decreasing nystag |
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Term
| Treatment for nystag: Visual Biofeedback |
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Definition
| Glasses that help you focus with lights. Moves null point to the right place. |
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Term
| Treatment for nystag: Auditory Feedback |
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Definition
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Term
| Treatment for nystag: Amblyoscope/Synoptophore |
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Definition
| Major amblyoscope. Flashes a red light for several minutes. takes weeks, but long lasting effect. |
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Term
Review of convergence (erin d. and Erica W.)
4 convergence issues |
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Definition
REVIEW OF VERGENCE
Case Review of Convergence (Erin Davis, and Erica Wiegandt)
INO: disorder of conjugate lateral gaze. Affected eye cannot ADDUCT
The non-affected eye displays nystagmus on ABDUCTION (trying to recruit)
Convergence is spared
Cause: older adults = lesion of MLF. Younger adults = demyelinating disease (MS)
Convergence Retraction Nystagmus: co-contraction of MR muscles
Jerk nystagmus induced by downward OKN stimulation.
Upward refixation brings the two eyes together
Cause: Parinaud Syndrome (lesion of upper brainstem. Paralysis of up-gaze)
Whipple: bacteria. Symptoms: malabsorption, wt loss, arthritis. M > W. Antibiotics.
Argyll-Robertson Pupil: constrict w/ accommodative convergence, but not with light
Edinger-Westphal nucleus (responsible for pupil constriction, accom, convergence)
Clinically: test accommodative convergence in pt that has tonic pupils to DDx.
Causes: not just neurpsyphilis. Parinaud. Brain injury. Thiamine (B12) Deficiency. |
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Term
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Definition
Upbeat nystag. Eyes beat drift toward lesion (corrective saccades away?)
Whole body drifts (hiccups, polydactyly)
Treat: yoked prism. |
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Term
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Definition
-Vertical saccades are oblique. Head tilt toward lesion.
-Hypermetric saccades toward leison, hypometric away.
-Drift to the affected side when eyes closed
-ipsilateral ptosis and horner's
-SKEW deviation (looks like 4th or 3rd nerve)
Where: Dorsal medulla
From: Ipsilateral vertebral artery occlusion, Posterior inferior cerebellar artery occlusion, Vertebral artery dissection, MS |
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Term
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Definition
APN! with palate tremor
Treatment: Gabapentin
STROKE
Problem in: Central tegmental track, Olivary nucleus (medulla), red nucleus (midbrain), Dentate nucleus (cerebellum) |
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Term
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Definition
Upbeat Nystag. Downdrift of eyes. Horizontal. Gaze evoked nystag.
Prob in: anterior canals pathway interrupted |
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Term
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Definition
| Horizontal gaze palsy. Cant look to the side with the lesion in either eye. |
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Term
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Definition
| Slowed saccades toward side with lesion. (Pons) |
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Term
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Definition
Unilateral: Eye on the side of the lesion can't cross the midline.
Bilateral: neither eye can cross the midline when looking toward the opposite side.
But they can when converging!
Cause: Stroke, MS, tumor, arnold Chiari |
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Term
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Definition
pons
INO+6th nerve prob.
Only one eye can abduct. But it works when converging. |
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Term
| NRTP (Nucleus Reticularis Tegmenti Pontis) lesions |
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Definition
INO + impaired vergence. (pons)
Torisional saccades. Maybe exo. |
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Term
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Definition
Unilateral: Slow or Palsy of down-saccades
contralesional down-nystag
Bilateral: No more vertical saccades
Basilar syndome (actually) acute loss of down saccades. and Jocular behavior
Area affected: rMLF
Also -Vertical 1.5 syndrome. |
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Term
Dorsal Midbrain
(Pretectal/Parinaud) |
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Definition
Restricted up-movements. CONVERGENCE WHEN THEY TRY AND LOOK PLACES.
Fixation instability.
APD in contralateral eye.
Skew deviation.
Cause: Posterior Commisure lesions! COLLIER'S LID SIGN. |
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Term
| Interstitial Nucleus of Cajal |
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Definition
Impairs gaze holding. Impairs all vertical movements.
SKEW (tilts AWAY from lesion, as opposed to Wallenberg) |
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Term
| Midbrain Lesion and Abduction |
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Definition
| Thalamic ESO!! lookse like 6th nerve palsy. Lesion is btw the third and sixth. |
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Term
| Progressive Subranuclear Palsy |
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Definition
Progressively lose verticals, down first.
Condition: Presents like Parkinsons. Ask them to clap 3 times and they can't stop clapping. |
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Term
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Definition
| Pendular convergence retraction nystag! Pathepnumonic. Myoclonus. Looks like PSP. |
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Term
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Definition
Bilateral INO, Gaze nystag. Eso mimicking 6th nerve palsy.
All sorts ov other nystags and flutter. Gaze palzies and spasms.
Pred helps w/ visual symptoms, but not ORAL pred. |
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Term
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Definition
Triad: Ophthalmoplegia, ataxia, "global confusional state"
corrective sacades to make up for bad slow phase response.
Gaze evoked or positional nystag. |
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Term
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Definition
Catchup saccades, b/c pursuits aren't working
Saccadic intusions: Poor supression of superior coliculus, and bad attention shifting.
Poor contrast, depth and motion. |
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Term
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Definition
Increased Latency of vertical saccades
Fixation instabilit
Antisacade error
Apraxia. |
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Term
| Skeffington's four circles of vision |
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Definition
1. Antigravity- VOR OKN
2. Centering- saccades, magno, vergence
3. Identification- pursuits, parvo, accommodation, fixations
4. Speech and language- Brocas. |
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Term
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Definition
Ipsilateral Hypometria
(cerebellum) |
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Term
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Definition
| overshoot in the direction of the lesion (like lateropulsion and wallenburg) |
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Term
| Flocculus and Paraflocculus |
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Definition
Gaze evoked rebound nystag.
Catch up saccades w/ pursuits (like w/ aids)
Bad VOR
Jerky |
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Term
| Nodulus and Uvular Lesions |
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Definition
PAN
Prolonged VOR
DOWNBEAT. |
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Term
| Vascular Cerebellar Infarction |
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Definition
Superior Cerebellar artery- Hypermetric contralesional saccades. Hypometric ipsi.
Posterier Inf Cerebel Art- Looks like wallenberg
Anterior inferior Cerebellar art- Gaze pasly Bells palsy |
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Term
| Arnold Chiari Malformation |
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Definition
congential cerebellum
Downbeat nystag. Worse in lateral gaze
Type 1- adult onset, vermis herniation
Type 2- hydrocephalus, myelomeningocele
Type 3- bad birth defect, neural tube wont close. Teratogens |
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Term
| Dandy-Walker Malformation |
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Definition
WARFARIN/COUMADIN DURING PREGNANCY.
cerebellum malf. Nystagmus/ strab/ instability |
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Term
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Definition
cerebellum congenital
Persistant Hyperplastic Primary Vitreous- Malformaiton of vitesous. glial tissue wrong in the eye. Looks like ROP.
AR. Muscular dystrophy, coloboma |
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Term
| Type 1 and 2 Episondic Ataxia |
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Definition
Type 1
-Barrel chested kids
-triggered by stress
-eye lid twitch
up to age 20
Type 2- up to age 30
Nystag, VOR OKN saccades pursuits, migrains |
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Term
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Definition
Episodes of clumsiness, migrains, and extremely paiful nerualgia
-Triggered by stress, up to age 50
-Peripheral vestibuar nystagmus
-ACETAZOLAMIDE |
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Term
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Definition
Degereration of coordination of body and eyes.
Retinopathy, Salt and Pepper fundus. |
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