Abstract
Purpose :
To determine the value of ordering magnetic resonance imaging (MRI) in children presenting with nystagmus as the primary presentation without an underlying neurologic abnormality.
Methods :
Retrospective chart review of patients: newborns to age 17 imaged at Children’s Medical Center in Dallas, TX between 1/2014 – 3/2015 with a diagnosis of nystagmus. Exclusion criteria included patients with a known underlying neurologic disease known to be associated with nystagmus or patients with incomplete medical records. Patients were divided into 3 groups: Group A: Nystagmus patients with normal eye exams. Group B: Nystagmus patients with abnormal eye exams. Group C: Nystagmus patients not examined by an ophthalmologist; but diagnosed by neurologists or neurosurgeons. Results of MRI, systemic findings associated with nystagmus as well as incidence of Down syndrome were all reviewed.
Results :
69 cases were initially identified, 52 met the inclusion criteria. 69% were males, 31% were females. Age at the time of imaging: 6 months - 10 years with an average age of 21 months. MRI was normal in all patients in Group A (22 of 22), 45% of patients in Group B (10 of 22), and 87% of patients in Group C (7of 8). Most common abnormality noted was abnormal head posture (36% 19/52), strabismus (19%, 10/52), and optic pallor/ hypoplasia (19%, 10/52). All of the cases with abnormal MRI had an abnormal eye exam. None of the abnormalities found on MRI was life threatening. Only 4 cases (all in group A) had Down syndrome constituting 8% of total patients. Types of nystagmus along with specific MRI findings will be discussed.
Conclusions :
Our study suggests that there is no added benefit in ordering MRI in cases presenting with nystagmus as the primary diagnosis in which the eye exam is otherwise normal. In cases with underlying abnormal eye exams especially hypoplasia or pallor of the optic disc, an MRI is beneficial. Rate of Down syndrome in nystagmus patients is less than 10% (in agreement with previously published studies). Value of ordering MRI in nystagmus patients with known underlying neurologic abnormality is beyond the scope of this paper.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.