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Teaching Video NeuroImages: Video-ophthalmoscopy
John J. Millichap, MD
Nystagmus from the inside
John Alexander Fraser, MD
A 60-year-old man had worsening vertical oscillopsia and was ultimately diagnosed with idiopathic downbeat nystagmus. The nystagmus was subtle and more noticeable with slit-lamp magnification (video 1 at Neurology.org), but direct ophthalmoscopy revealed marked (upbeat) nystagmus of the fundus (video 2). Direct ophthalmoscopes are ubiquitous and have 153 magnifying power. Their use in detecting and magnifying subtle nystagmus was first described by Zee.1 Because the optic disc sits behind the axis of rotation of the globe, its motion is opposite the front of the eye; therefore, our patient’s subtle downbeat
Correspondence to Dr. Fraser: [email protected]
nystagmus appears as obvious upbeat nystagmus of the fundus. STUDY FUNDING No targeted funding reported.
DISCLOSURE The author reports no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
REFERENCE 1. Zee DS. Ophthalmoscopy in examination of patients with vestibular disorders. Ann Neurol 1978;3:373–374.
Supplemental data at Neurology.org Download teaching slides: Neurology.org
From the Departments of Clinical Neurological Sciences and Ophthalmology, Western University, London, Canada. e210
© 2016 American Academy of Neurology
ª 2016 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
Teaching Video NeuroImages: Video-ophthalmoscopy
John J. Millichap, MD
Nystagmus from the inside
John Alexander Fraser, MD
A 60-year-old man had worsening vertical oscillopsia and was ultimately diagnosed with idiopathic downbeat nystagmus. The nystagmus was subtle and more noticeable with slit-lamp magnification (video 1 at Neurology.org), but direct ophthalmoscopy revealed marked (upbeat) nystagmus of the fundus (video 2). Direct ophthalmoscopes are ubiquitous and have 153 magnifying power. Their use in detecting and magnifying subtle nystagmus was first described by Zee.1 Because the optic disc sits behind the axis of rotation of the globe, its motion is opposite the front of the eye; therefore, our patient’s subtle downbeat
Correspondence to Dr. Fraser: [email protected]
nystagmus appears as obvious upbeat nystagmus of the fundus. STUDY FUNDING No targeted funding reported.
DISCLOSURE The author reports no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
REFERENCE 1. Zee DS. Ophthalmoscopy in examination of patients with vestibular disorders. Ann Neurol 1978;3:373–374.
Supplemental data at Neurology.org Download teaching slides: Neurology.org
From the Departments of Clinical Neurological Sciences and Ophthalmology, Western University, London, Canada. e210
© 2016 American Academy of Neurology
ª 2016 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
