March 2012
Volume 53, Issue 14
ARVO Annual Meeting Abstract  |   March 2012
Four Patients Demonstrating That There Are At Least Three Ways That Two Types Of Nystagmus Can Coexist In One Patient
Author Affiliations & Notes
  • Michael L. Rosenberg
    Neurology, New Jersey Neuroscience Institute, Edison, New Jersey
  • Footnotes
    Commercial Relationships  Michael L. Rosenberg, None
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Investigative Ophthalmology & Visual Science March 2012, Vol.53, 515. doi:
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      Michael L. Rosenberg; Four Patients Demonstrating That There Are At Least Three Ways That Two Types Of Nystagmus Can Coexist In One Patient. Invest. Ophthalmol. Vis. Sci. 2012;53(14):515.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : It is well known that a physiologic nystagmus such as horizontal OKN or vestibular nystagmus can vectorially add with a different physiologic or pathologic nystagmus. Four patients are presented demonstrating two other ways that two different types of nystagmus can exist in the same patient.

Methods: : Four patients seen in neuro-ophthalmologic consultation are described.

Results: : The first two patients had a primary position horizontal nystagmus. After horizontal headshaking there was a brisk nystagmus in the opposite direction. After vertical headshaking there was an increased nystagmus in the original direction. It is assumed that the primary position nystagmus was central and that a latent peripheral nystagmus was brought out with headshaking. Two additional patients with MS had a primary position pendular nystagmus that converted to a jerk nystagmus on lateral gaze to either side. Recordings of both patients showed that there was a smaller amplitude, higher frequency nystagmus with a different wave form superimposed on the gaze-evoked nystagmus.

Conclusions: : There are at least three mechanisms by which nystagmus of different types can exist in the same patient.1) Vector summation of two types of nystagmus sharing a single beat frequency.2) A manifest central vestibular nystagmus with cancellation of a peripheral vestibular nystagmus that can be brought out with head shaking.3) A superimposition of two different types of nystagmus with different wave forms and different frequencies.

Keywords: nystagmus • neuro-ophthalmology: diagnosis • eye movements 

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