Neurology
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Right arrow Clinical neurology examination
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Matthew J. Thurtell, MBBS, Konrad P. Weber, MD and G. Michael Halmagyi, MD

From the Department of Neurology (M.J.T., K.P.W., G.M.H.), Institute of Clinical Neurosciences, Royal Prince Alfred Hospital and the University of Sydney, Australia; and Department of Neurology (M.J.T.), University Hospitals Case Medical Center, and the Daroff-Dell'Osso Ocular Motility Laboratory, Louis Stokes Department of Veterans Affairs Medical Center, Cleveland, OH.


Figure 117
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  		Figure 1 Three-dimensional search-coil recordings of the patient's nystagmus

The patient is attempting to fixate leftward (A), central (B), and rightward (C) targets (Fix), indicated by arrowheads next to the horizontal traces. The traces show leftward-upward-counterclockwise jerk nystagmus (A), alternating-direction horizontal-torsional jerk nystagmus with extended foveation (B), and rightward-upward-clockwise jerk nystagmus with extended foveation (C). Each nystagmus slow phase increases in velocity with time. Positive directions are rightward, upward, and clockwise, as indicated.

 

Figure 217
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  		Figure 2 Typical nystagmus waveforms

(A) Increasing-velocity slow phase waveform typical of congenital nystagmus. (B) Decreasing-velocity slow phase waveform typical of cerebellar gaze-evoked nystagmus. (C) Constant-velocity slow phase waveform typical of vestibular nystagmus. Position of fixation target (Fix) is indicated by arrowheads. While the search-coil technique is the current gold standard, satisfactory eye movement recordings can be obtained using electro-oculography, infrared-, or video-based techniques, often through a neuro-otology or otolaryngology service.

 




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