Accepted Manuscript Eye Jerking Trick, no Need to Panic Ghosh Debabrata , MD PII:
S0887-8994(14)00330-0
DOI:
10.1016/j.pediatrneurol.2014.05.026
Reference:
PNU 8382
To appear in:
Pediatric Neurology
Received Date: 17 April 2014 Accepted Date: 30 May 2014
Please cite this article as: Debabrata G, Eye Jerking Trick, no Need to Panic, Pediatric Neurology (2014), doi: 10.1016/j.pediatrneurol.2014.05.026. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
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Eye Jerking Trick, no Need to Panic
Debabrata Ghosh, MD, Associate Professor, Division of Pediatric Neurology, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, Ohio
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e-mail: [email protected]
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Corresponding address:
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Debabrata Ghosh, MD; Division of Child Neurology ED 577; Nationwide Children’s Hospital; Ohio State University College of Medicine; 700 Children’s Drive; Columbus, OH 43205.
Key words: Nystagmus, Oscillopsia, Ocular flutter, Eyelid flutter, Visual acuity Word count: 379
ACCEPTED MANUSCRIPT
Case description:
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A 10-year-old boy, while being examined for headache, volunteered to demonstrate his ‘tricking skill’ with shaking of his eyes as noted in the attached video (Figure). This voluntary “ocular flutter” was more prominent during attempted convergence. On request he could reproduce those movements voluntarily multiple times. He had no visual dysfunction associated with the nystagmus. He had an otherwise normal clinical examination which included a visual acuity of 20/20, normal voluntary conjugate eye movements in all directions, and a normal fundoscopic examination. There was no ataxia or any motor or sensory deficit.
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Discussion/Learning points:
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Voluntary nystagmus is noted in about 8% of the college students.1 Typically it starts manifesting at about 8-10 years of age. As noted in the video, this low amplitude fast frequency, mostly (>95%) horizontal ‘to-and-fro’ jerky eye movement is alternatively called as ‘voluntary ocular flutter’, or ‘ocular tremor’. This is often associated with eye lid flutter. This type of nystagmus is more prominent while attempting to focus the eyes, brief lasting for 5-20 seconds, and most importantly, voluntarily reproducible.2,3 Typically there is normal vision, fundus, and ocular gaze. Rarely there may be oscillopsia (the shaking of the objects seen), if these episodes are frequent. Using an plus ocular lens to prevent accommodation/convergence may be helpful, if oscillopsia is troublesome.4
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Pediatricians, and more specifically, Pediatric Neurologists should be aware of occurrence of such benign voluntary phenomenon, in an otherwise normal child. It can run in families. This video report is aimed to increase the familiarity of voluntary nystagmus to the clinicians, and, thereby, avoid unnecessary and expensive investigation/s.
ACCEPTED MANUSCRIPT
Legend to the Figure (video):
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The accompanying video shows the fast frequency, low amplitude, horizontal, to-and-fro, ocular flutter-like eye movement, produced and reproduced voluntarily. It becomes more prominent when the patient focuses forward with attempted convergence of eyes. Please note associated eye lid flutter on occasion during the voluntary nystagmus. Eye movements on formal examination were normal.
References:
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1. Zahn JR. Incidence and characteristics of voluntary nystagmus. J Neurol Neurosurg Psychiatr. 1978; 41: 617-623. 2. Higgins GC, Stultz KF. Frequency and amplitude of ocular tremor. J Optical Soc Am. 1953; 43: 1136. 3. Bassani R. Voluntary Nystagmus. N Engl J Med. 2012; 367: e13.
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4. Neppert B, Rambold H. Familial Voluntary Nystagmus. Strabismus. 2006; 14: 115-119.
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ACCEPTED MANUSCRIPT
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ACCEPTED MANUSCRIPT
S0887-8994(14)00330-0
DOI:
10.1016/j.pediatrneurol.2014.05.026
Reference:
PNU 8382
To appear in:
Pediatric Neurology
Received Date: 17 April 2014 Accepted Date: 30 May 2014
Please cite this article as: Debabrata G, Eye Jerking Trick, no Need to Panic, Pediatric Neurology (2014), doi: 10.1016/j.pediatrneurol.2014.05.026. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
RI PT
Eye Jerking Trick, no Need to Panic
Debabrata Ghosh, MD, Associate Professor, Division of Pediatric Neurology, Nationwide Children’s Hospital, Ohio State University College of Medicine, Columbus, Ohio
M AN U
SC
e-mail: [email protected]
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Corresponding address:
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EP
Debabrata Ghosh, MD; Division of Child Neurology ED 577; Nationwide Children’s Hospital; Ohio State University College of Medicine; 700 Children’s Drive; Columbus, OH 43205.
Key words: Nystagmus, Oscillopsia, Ocular flutter, Eyelid flutter, Visual acuity Word count: 379
ACCEPTED MANUSCRIPT
Case description:
RI PT
A 10-year-old boy, while being examined for headache, volunteered to demonstrate his ‘tricking skill’ with shaking of his eyes as noted in the attached video (Figure). This voluntary “ocular flutter” was more prominent during attempted convergence. On request he could reproduce those movements voluntarily multiple times. He had no visual dysfunction associated with the nystagmus. He had an otherwise normal clinical examination which included a visual acuity of 20/20, normal voluntary conjugate eye movements in all directions, and a normal fundoscopic examination. There was no ataxia or any motor or sensory deficit.
SC
Discussion/Learning points:
TE D
M AN U
Voluntary nystagmus is noted in about 8% of the college students.1 Typically it starts manifesting at about 8-10 years of age. As noted in the video, this low amplitude fast frequency, mostly (>95%) horizontal ‘to-and-fro’ jerky eye movement is alternatively called as ‘voluntary ocular flutter’, or ‘ocular tremor’. This is often associated with eye lid flutter. This type of nystagmus is more prominent while attempting to focus the eyes, brief lasting for 5-20 seconds, and most importantly, voluntarily reproducible.2,3 Typically there is normal vision, fundus, and ocular gaze. Rarely there may be oscillopsia (the shaking of the objects seen), if these episodes are frequent. Using an plus ocular lens to prevent accommodation/convergence may be helpful, if oscillopsia is troublesome.4
AC C
EP
Pediatricians, and more specifically, Pediatric Neurologists should be aware of occurrence of such benign voluntary phenomenon, in an otherwise normal child. It can run in families. This video report is aimed to increase the familiarity of voluntary nystagmus to the clinicians, and, thereby, avoid unnecessary and expensive investigation/s.
ACCEPTED MANUSCRIPT
Legend to the Figure (video):
SC
RI PT
The accompanying video shows the fast frequency, low amplitude, horizontal, to-and-fro, ocular flutter-like eye movement, produced and reproduced voluntarily. It becomes more prominent when the patient focuses forward with attempted convergence of eyes. Please note associated eye lid flutter on occasion during the voluntary nystagmus. Eye movements on formal examination were normal.
References:
M AN U
1. Zahn JR. Incidence and characteristics of voluntary nystagmus. J Neurol Neurosurg Psychiatr. 1978; 41: 617-623. 2. Higgins GC, Stultz KF. Frequency and amplitude of ocular tremor. J Optical Soc Am. 1953; 43: 1136. 3. Bassani R. Voluntary Nystagmus. N Engl J Med. 2012; 367: e13.
AC C
EP
TE D
4. Neppert B, Rambold H. Familial Voluntary Nystagmus. Strabismus. 2006; 14: 115-119.
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EP
TE D
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ACCEPTED MANUSCRIPT
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ACCEPTED MANUSCRIPT
