Torsional Nystagmus
• A 22 year old girl came for a regular checkup. She gave history for surgery done for Hydrocephalus 1 year back. She is also on anti-epileptic medications for seizure disorder. On slit-lamp, we found the appearance of a torsional nystagmus
What is nystagmus?
• Periodic, involuntary movements of one or both eyes in a fast or slow oscillatory motion
• Nystagmus starts by a slow movement of the eye away from the visual target
• The second movement brings the eye back to the visual target
• Rotary (or torsional) nystagmus is an involuntary, circular or rotating movement of the eyes
• It often accompanies other directions of eye-shaking, but when it is the primary or pure form, it typically indicates an underlying issue with the central vestibular system
Common Causes
• Central Nervous System Disorders: Multiple sclerosis (MS), brain tumors, or strokes
• Vestibular System Issues: Conditions affecting the inner ear or balance centers in the brain, such as vestibular neuronitis or labyrinthitis
• Head or Eye Trauma: Physical injury to the brain or visual pathways
• Medications: Certain drugs like anti-epileptics or ototoxic medications can trigger it
Symptoms
• A sensation that their surroundings or the room is spinning (vertigo)
• Shaky, unsteady, or blurry vision
• Balance problems and dizziness
• A natural tendency to turn or tilt their head to try and stabilize their vision
Diagnosis:
• Detailed neurological and physical examinations
• Videonystagmography (VNG): A test that uses video goggles to track and record eye movements
• Imaging Studies: MRI or CT scans to rule out brain tumors, strokes, or MS plaques
Image from Rajan Eye Care Hospital
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