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Michael L. Rosenberg; Four Patients Demonstating That There Are At Least Three Ways That Two Types Of Nystagmus Can Coexist In One Patient. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4699.
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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.
Four patients seen in neuro-ophthalmologic consultation are described.
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 superimposed on the gaze-evoked nystagmus.
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 brought out with head shaking.3) A superimposition of two different types of nystagmus with different wave forms and different frequencies..
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