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A. Tabuchi, H. Kamao, Y. Kamao, M. Oka, F. Maeda; Treatment of Vertical Nystagmus in Chiari Malformation . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2937.
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Purpose: Chiari malformation causes oscillopsia and visual disturbance because of intractable vertical nystagmus. We report on the various forms of treatment for a case with vertical nystagmus which remained after a neurosurgical operation. Methods: A case report. Results: The case was 32 years old Japanese woman who became aware of oscillopsia around April 1995. She was examined in the Department of Ophthalmology, Kawasaki Medical School Hospital, in May 1995. We recognized vertical nystagmus to the lower part and convergence weakness at the time of primary position.Eye ocular movements were normal. A C1 laminectomy was performed in the Department of Neurosurgery, Kawasaki Medical School Hospital on July 24, 1995, but her oscillopsia remained after the operation. She became aware of visual disturbance in July 2000. This oscillopsia and visual disturbance improved with the administration of steroids. However, she became aware of idiopathic deafness and noticed the return of oscillopsia and visual disturbance in October 2000. As a therapeutic method, she tried contact lenses in May 2001, and her oscillopsia and visual disturbance improved. However, the oscillopsia and visual disturbance returned again in about February 2002. Because the contact lenses then proved ineffective, she tried Acetazolamide. With this treatment, her oscillopsia and visual disturbance improved, but this was effective for only two months. Since treatment with Clonazepam from April 2004, she has not experienced any oscillopsia and visual disturbance. Conclusions: Long term control of vertical nystagmus with Chiari malformations is very difficult. We recognized that surgery, administration of steroid medicine and anticonvulsant medicine, and contact lenses can be effective during fixed periods. The selected treatment of nystagmus is important, because it has a remarkable influence on daily life.
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