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Gaze Palsy in Children: What is Underneath? - A Review Article

Entry Date gaylord, n. Oxford University Press. Subscriber account Username. Fixation suppression can be eliminated by having the patient's eyes open in a dark room with Frenzel lenses or dark goggles used for infrared assessment. In addition, the patient may be asked to participate in a number of mental tasks eg, answering questions, counting by multiples of 2.

Square-wave jerks are the most common abnormality found with eyes closed absence of visual fixation. Caution must be exercised in the interpretation of square-wave jerks. Many healthy patients exhibit this pattern with their eyes closed. Furthermore, the frequency of square-wave jerks increases with age. In young patients, square-wave jerks may be considered atypical if they occur more frequently than once per second or with visual fixation.

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In such cases, square-wave jerks are suggestive of a cerebellar disorder. Spontaneous nystagmus may indicate either central or peripheral pathology. The presence of nystagmus with visual fixation is always diagnostically significant. Peripheral indicators include horizontal or horizontal rotary nystagmus, nystagmus suppressed by visual fixation, non—direction-changing nystagmus, and nystagmus exacerbated by gazing in the direction of the fast phase. Central indicators include vertical nystagmus, nystagmus not suppressed by fixation, and direction-changing nystagmus.

By Alexander's law, nystagmus evident with visual fixation always beats in the same direction and increases when the patient gazes in the direction of the fast phase. Nystagmus decreases or disappears when the patient gazes in the direction opposite to the fast phase. This pattern is often seen in peripheral vestibular disorders and occasionally in central disorders. Unilateral gaze-paretic nystagmus only occurs with eccentric gaze in one direction. Elicited nystagmus beats in the direction of the gaze.

This is consistent with CNS pathology. With bilateral gaze-paretic nystagmus, when the patient gazes to the right, nystagmus is elicited that beats to the right; when the patient gazes to the left, left-beating nystagmus occurs. This pattern suggests CNS pathology. Bruns nystagmus is a combination of unilateral gaze-paretic nystagmus and vestibular nystagmus, which is evidenced as nystagmus in both directions of a gaze that is asymmetrical.

Bruns nystagmus is associated with extra-axial mass lesions on the side of the gaze-paretic nystagmus. Congenital nystagmus often has a spiky appearance and increases with lateral gaze. Congenital nystagmus may decrease in velocity or completely disappear in the absence of visual fixation. Rebound nystagmus is characterized by a burst of nystagmus that lasts approximately 5 seconds and begins when the eyes return to center gaze.

When this is present, the clinician may suspect brainstem or cerebellar lesions. For peripheral lesions, nystagmus that is evident with eyes closed or in the dark should be suppressed by visual fixation. If visual fixation does not suppress nystagmus, CNS pathology is possible. J Int Adv Otol. Challenges in evaluating the oculomotor function in individuals with Rett syndrome using electronystagmography. Eur J Paediatr Neurol. Ocular motor syndromes of the brainstem and cerebellum.

Curr Opin Neurol. Stockwell CW. Incidence of ENG Abnormalities. Insights in Practice.

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Electronystagmography versus videonystagmography. Braz J Otorhinolaryngol. Electronystagmography versus videonystagmography in diagnosis of vertigo. Disorders of saccades. Curr Neurol Neurosci Rep. What clinical disorders tell us about the neural control of saccadic eye movements. Square wave jerks in children and adolescents. Pediatr Neurol. Jonathan Talmud. Dix Hallpike Maneuver.

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