Nystagmus series – Part V
(torsional/rotatory nystagmus)
“the only ophthalmologist 'who practiced ophthalmology' to win a Nobel Prize”
Swedish ophthalmologist Allvar Gullstrand (1862–1930)
(dioptrics of the eye)
#MedTwitter #neurotwitter #EndNeurophobia #tweetorials
1/
Pathophysiology
“lesions in midbrain and medulla”
Central
- pure torsional: medulla (pontomedullary junction)
- up/down: midbrain (rostral interstitial nucleus of the medial longitudinal fasciculus)
Peripheral
- horizontal: anterior and posterior semicircular canals
2/
Fixation in central vestibular nystagmus
“poorly suppressed by fixation of a visual target”
- abnormal smooth-pursuit system
3/
Making torsional nystagmus more noticeable
Modulated by vertical smooth pursuit movements
Bedside maneuvers
- change head position
- vigorous head-shaking
4/
Obs
a) minimal vertical&horizontal components, in pure torsional
b) slow-phase without specific waveform
c) may be suppressed by convergence
d) often, ocular tilt reaction or unilateral internuclear ophthalmoplegia
5/
Obs
e) most useful technique for seeing primary positional torsional nystagmus is fundoscopy
- ectoscopy, look conjunctival vessels
f) torsional components in peripheral vestibular, congenital, and seesaw nystagmus (lateral gaze)
6/
Torsional nystagmus – features
i) no suppress by visual fixation
ii) may be suppressed by convergence
iii) modulated by vertical smooth pursuit
7/
Torsional nystagmus – features
i) no suppress by visual fixation
ii) may be suppressed by convergence
iii) modulated by vertical smooth pursuit
jerk torsional nystagmus
dizziness-and-balance.com via: Timothy C. Hain
8/
Torsional nystagmus – features
i) no suppress by visual fixation
ii) may be suppressed by convergence
iii) modulated by vertical smooth pursuit
pendular torsional nystagmus
dizziness-and-balance.com via: Timothy C. Hain
9/
Torsional nystagmus – features
i) no suppress by visual fixation
ii) may be suppressed by convergence
iii) modulated by vertical smooth pursuit
congenital torsional nystagmus
dizziness-and-balance.com via: Timothy C. Hain
10/
Torsional nystagmus – features
i) no suppress by visual fixation
ii) may be suppressed by convergence
iii) modulated by vertical smooth pursuit
jerk torsional nystagmus (BPPV)
dizziness-and-balance.com via: Timothy C. Hain
11/
Torsional nystagmus – features
i) no suppress by visual fixation
ii) may be suppressed by convergence
iii) modulated by vertical smooth pursuit
pure torsional nystagmus
via: Audiology-Vestibular Science Academy
12/
Torsional nystagmus – features
i) no suppress by visual fixation
ii) may be suppressed by convergence
iii) modulated by vertical smooth pursuit
via: Aaron Fletcher
13/
Torsional nystagmus – features
i) no suppress by visual fixation
ii) may be suppressed by convergence
iii) modulated by vertical smooth pursuit
via: Akhemete Semlii Jakvuc Vandiev
14/
Torsional nystagmus – features
i) no suppress by visual fixation
ii) may be suppressed by convergence
iii) modulated by vertical smooth pursuit
via: Darius Rejali
15/
Torsional nystagmus – features
i) no suppress by visual fixation
ii) may be suppressed by convergence
iii) modulated by vertical smooth pursuit
via: Moran CORE
16/
Torsional nystagmus – features
i) no suppress by visual fixation
ii) may be suppressed by convergence
iii) modulated by vertical smooth pursuit
via: Slit Lamp Studios
17/
Nystagmus general description
"Nystagmus – Moving eyes!!!"
18/
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