Downbeat nystagmus with supra-tentorial disease

Lavin, P. J. M.; Bahntge, M. F.

doi:10.3109/01658108308997310

Cited by 3 publications

(2 citation statements)

References 12 publications

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“…It is associated with a wide range of brainstem and cerebellar disease. Downbeat nystagmus is usually related to abnormalities of the craniocervical junction, but can also occur in cerebellar disease,2 with increased intracranial pressure3 4 and secondary to anticonvulsant drugs 5. Upbeat nystagmus is a rarer condition and can be associated with cerebellar and pontomedullary abnormalities6-8 and as a consequence of drug or organophosphate toxicity 9…”

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confidence: 99%

Vertical or asymmetric nystagmus need not imply neurological disease

Shawkat

Kriss²,

Thompson³

et al. 2000

British Journal of Ophthalmology

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Aim-To indicate that congenital idiopathic nystagmus (CIN) and sensory defect nystagmus (SDN) can be vertical or asymmetric in some children. Methods-Of 276 children presenting with nystagmus for electrophysiological testing, 14 were identified as having CIN or SDN, yet had a nystagmus which was either vertical (n=11) or horizontal asymmetric (n=3). Flash electroretinograms and flash and pattern visual evoked potentials (VEPs) were recorded in all patients. Eye movement assessment, including horizontal optokinetic nystagmus (OKN) testing, was carried out in 11/14 patients. Results-Eight patients (seven with vertical, one with asymmetric horizontal nystagmus) had congenital cone dysfunction. One patient with vertical and another with asymmetric nystagmus had cone-rod dystrophy. One patient with vertical upbeat had congenital stationary night blindness. Two patients (one downbeat, one upbeat nystagmus) had normal electrophysiological, clinical, and brain magnetic resonance imaging findings and were classified as having CIN. One patient with asymmetric nystagmus showed electrophysiological and clinical findings associated with albinism. Horizontal OKN was present in 80% of patients tested, including the three cases with horizontal asymmetric nystagmus. This is atypical in both CIN and SDN, where the OKN is usually absent. Conclusions-Vertical and asymmetric nystagmus are most commonly associated with serious intracranial pathology and its presence is an indication for neuroimaging studies. However, such nystagmus can occur in children with retinal disease, albinism, and in cases with CIN. These findings stress the importance of noninvasive VEP/ERG testing in all cases of typical and also atypical nystagmus. (Br J Ophthalmol 2000;84:175-180)

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confidence: 99%

Vertical or asymmetric nystagmus need not imply neurological disease

Shawkat

Kriss²,

Thompson³

et al. 2000

British Journal of Ophthalmology

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“…'*' 123COGAN (1968)9 reported the combination of horizontal nystagmus on gaze to either side with ,DBN in 12 ouf of 27 patients, and also described a 16 year-old girl with inconstant but definite DBN on downward gaze and a fine jerk nyslugmus OK gaze to either side. The combined occurrence of a horizontal gazecoabd nystogmus and DBN was observed in a 35 year-old man(LAVIN & BAHNTGE, 1983)?%oth spontaneous DBN and bilateral gaze-evoked nystagmus have becn described in a 12 year-old girl(HAMID et al 1988), and in a 30 year-old woman (LONGRIDGE & MALLINSON 1985)24 YEE et al (1979?lnvestigated a 22 year-old woman with DBN in lateral and downgaze, who also demonstrated horizontal rebound nystagmus. Some of the five patients who had vqrtical nystagmus, seen by MEHDORN et al (1979206 displayed horizontal gaze-directed and rebound nystagmus.…”

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confidence: 93%

Downbeat nystagmus

Schmidt¹

1991

NOPH

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Localizing significance : Downbeat nystagmus (DBN) was found in lesions in the posterior fossa close to the medullocervical (craniocervical) junction, of the floor of the 4th ventricle and of the cerebellum, especially of the cerebellar flocculi. The occurrence of DBN in a patient demands special differential-diagnostic considerations in neuro-ophthalmology. Both congenital and acquired diseases were found in patients with this special kind of nystagmus.Clinical evaluation has proved a multifactorial cause of DBN. About one-third of the patients with this sign show an Arnold-Chiari malformation. In a cerebellar degeneration this vertical nystagmus type is not rare. It is essential to investigate all the family members to make diagnosis sure if a hereditary disease is suspected. Familial DBN due to spinocerebellar degeneration is one of the commonest causes of DBN. Hereditary downbeat nystagmus was described without additional neurological findings. Magnetic resonance imaging is the method of choice for investigating patients with DBN.Clonazepam, prism therapy, or a Kestenbaum-type operation, or artificial retinal image stabilization can be helpful in patients who suffer from nystagmus-induced oscillopsia.The mechanism of DBN remains controversial. The mechanism postulated for DBN supposes that it reflects imbalance of tonic vestibular control in the vertical canal system or, alternatively, that it results from defective smooth pursuit mechanisms in the vertical plane.A large series of 62 patients with DBN showed that in about 40% the cause remained undiagnosed despite detailed neurological and neuroradiological investigations.

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Neuro-otological findings in raised intracranial pressure

Fetter

1996

Intracranial and Intralabyrinthine Fluids

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Downbeat nystagmus with supra-tentorial disease

Cited by 3 publications

References 12 publications

Vertical or asymmetric nystagmus need not imply neurological disease

Vertical or asymmetric nystagmus need not imply neurological disease

Downbeat nystagmus

Neuro-otological findings in raised intracranial pressure

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