Nystagmus

Nystagmus

Q. 1 In which nystagmus occurs when the patient looks straight:
 A Latent
 B Deviational
 C Optokinetic
 D Central
Q. 1 In which nystagmus occurs when the patient looks straight:
 A Latent
 B Deviational
 C Optokinetic
 D Central
Ans. C

Explanation:

Optokinetic


Q. 2

. A 45 year male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from:

 A

Korsakoff’s psychosis

 B

Wernicke encephalopathy.

 C

De Clerambault syndrome

 D

Delirium tremens

Q. 2

. A 45 year male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from:

 A

Korsakoff’s psychosis

 B

Wernicke encephalopathy.

 C

De Clerambault syndrome

 D

Delirium tremens

Ans. B

Explanation:

B i.e. Wernicke encephalopathy


Q. 3

Down beat nystagmus could be due to:

 A

Cerebellar lesion

 B

Arnold-Chiari malformation

 C

Optic neuritis

 D

a and b

Q. 3

Down beat nystagmus could be due to:

 A

Cerebellar lesion

 B

Arnold-Chiari malformation

 C

Optic neuritis

 D

a and b

Ans. D

Explanation:

A i.e. Cerebellar lesion; B i.e. Arnold Chiari malformation

  • Down beat nystagmus (in primary position of gaze the fast component is downward) occurs from lesions near craniocervical junction (in posterior fossa near foramen magnum) e.g. Chiari malformation Q, basilar invagination. It has also been reported in cerebellar or brainstem stroke Q, lithium or anticonvulsant intoxication, alcoholism, and multiple sclerosis.
  • Upbeat nystagmus is associated with damage to pontine tegmentum from stroke, demylination or tumor.
  • Vestibular nystagmus results from dysfunction of labyrinth (Meniere’s disease), vestibular nerve or vestibular nucleus in brainstem.
  • Gaze evoked nystagmus is induced by drugs (sedatives, anticonvulsants, alcohol); muscle paresis; myasthenia gravis; dent disease; and cerebello-pontine angle, brainstem & cerebellar lesions.

Q. 4

A patient has a right homonymous hemian-opia with saccadic pursuit movements and defective optokinetic nystagmus. The lesion is most likely to be in the

 A

Frontal lobe

 B

Occipital lobe

 C

Parietal lobe

 D

Temporal lobe

Q. 4

A patient has a right homonymous hemian-opia with saccadic pursuit movements and defective optokinetic nystagmus. The lesion is most likely to be in the

 A

Frontal lobe

 B

Occipital lobe

 C

Parietal lobe

 D

Temporal lobe

Ans. C

Explanation:

C i.e. Parietal lobe

Optokinetic Nystagmus: If a white drum with vertical black stripes is rotated in front of the eyes, the patient follows the stripe till it disappears & then switches back suddenly to pick up a new stripe.

  • This reflex is abnormal in patients with congenital nystagmus. One may observe a paradoxical reversal of the optokinetic nystagmus response.
  • Patients with horizontal nystagmus with unilateral hemispheric lesions, especially parietal or parietal-occipital lesions, show impaired optokinetic nystagmus when the drum is rotated toward the side of the lesion.
  • The OKN drum may be used as an estimate of visual acuity. The striped drum is equivalent to a vision of counting fingers when held at a distance of 3-5 feet from the patient. The further the drum is from the patient, the better the visual acuity must be to respond normally to the moving drum.

Q. 5

Site of lesion in unilateral past pointing nystagmus is:

 A

Posterior semicircular canal

 B

Superior semicircular canal

 C

Flocculonodular node

 D

Cerebellar hemisphere

Q. 5

Site of lesion in unilateral past pointing nystagmus is:

 A

Posterior semicircular canal

 B

Superior semicircular canal

 C

Flocculonodular node

 D

Cerebellar hemisphere

Ans. D

Explanation:

Q. 6

In Fitzgerald Hallpike differential caloric test, cold-water irrigation at 30 degrees centigrade in the left ear in a normal person will include:

 A

Nystagmus to the right side

 B

Nystagmus to the left side

 C

Direction changing nystagmus

 D

Positional nystagmus

Q. 6

In Fitzgerald Hallpike differential caloric test, cold-water irrigation at 30 degrees centigrade in the left ear in a normal person will include:

 A

Nystagmus to the right side

 B

Nystagmus to the left side

 C

Direction changing nystagmus

 D

Positional nystagmus

Ans. A

Explanation:

Q. 7

Which of the following is not true of caloric test?

 A

Induction of nystagmus by thermal stimulation

 B

Normally, cold water induces nystatmus to opposite side and warm water to same side

 C

In canal paresis, the test is inconclusive

 D

None

Q. 7

Which of the following is not true of caloric test?

 A

Induction of nystagmus by thermal stimulation

 B

Normally, cold water induces nystatmus to opposite side and warm water to same side

 C

In canal paresis, the test is inconclusive

 D

None

Ans. C

Explanation:

 

 

  • Nystagmus can be induced both by cold as well as thermal stimulation
  • Cold stimulation causes nystagmus towards opposite side while thermal stimulation causes Nystagmus towards same side. (COWS)
  • In canal paresis either there is a reduced or absent response (causes of U/L canal paresis are-U/L vestibular Schwannoma or vestibular neuritis).
  • B/L absence of caloric nystagmus is seen in case of amminoglycoside ototoxicity or postmeningitis



Q. 8

Spontaneous vertical nystagmus is seen in the lesion of:

 A

Midbrain

 B

Labyrinth

 C

Vestibule

 D

Cochlea

Q. 8

Spontaneous vertical nystagmus is seen in the lesion of:

 A

Midbrain

 B

Labyrinth

 C

Vestibule

 D

Cochlea

Ans. A

Explanation:

Q. 9

True about central nystagmus:

 A

Horizontal

 B

Direction fixed

 C

Direction changes

 D

a and c

Q. 9

True about central nystagmus:

 A

Horizontal

 B

Direction fixed

 C

Direction changes

 D

a and c

Ans. D

Explanation:

 

  • Nystagmus is rhythmic oscillatory movement of eye and has two components slow and fast.
  • It can be of vestibular or ocular in origin
  • Vestibular nystagmus is called peripheral when it is due to lesion of labyrinth or VIllth nerve and central, when lesion is in the central neural pathways (Vestibular nuclei, brainstem and cerebellum)

 

Form

Direction of nystagmus° Latency

Duration

On visual fixation Accompanying symptoms Fafiguability

Example

Torsional with horizontal or vertical component Direction fixed

2-20 seconds

Less than 1 minute

Nystagmus disappears

Tinnitus, vertigo

Fatiguable

BPPV, labyrinthitis, Meniere’s disease labyrinthine fistula

Purely horizontal or vertical (No torsional component) Direction changing°

No latency

More than 1 minute Does not disappear None

Non fatiguable

Vertebrobasilar insufficiency, tumours



Q. 10

Nystagmus is associated with all EXCEPT:

 A

Cerebellar disease

 B

Vestibular disease

 C

Cochlear disease

 D

Arnold Chiari Malformation

Q. 10

Nystagmus is associated with all EXCEPT:

 A

Cerebellar disease

 B

Vestibular disease

 C

Cochlear disease

 D

Arnold Chiari Malformation

Ans. C

Explanation:

Cochlear problems is associated with hearing loss and not nystagmus.

Rest all are associated with nystagmus.


Q. 11

Spontaneous pure vertical nystagmus is seen in the lesion of:

 A

Medulla

 B

Labyrinth

 C

Middle ear

 D

Cochlea

Q. 11

Spontaneous pure vertical nystagmus is seen in the lesion of:

 A

Medulla

 B

Labyrinth

 C

Middle ear

 D

Cochlea

Ans. A

Explanation:

Q. 12

Destruction of right labyrinth causes nystagmus to:

 A

Right side

 B

Left side

 C

Pendular nystagmus

 D

No nystagmus

Q. 12

Destruction of right labyrinth causes nystagmus to:

 A

Right side

 B

Left side

 C

Pendular nystagmus

 D

No nystagmus

Ans. B

Explanation:

 

  • In destructive lesions eg. trauma to labyrinth, the nystagmus is towards the opposite side.
  • In irritative lesions eg. serous labyrinthitis, fistula of labyrinth, the nystagmus is towards ipsilateral side.

Q. 13

True about central nystagmus is:

 A

Duration not limited

 B

Direction fixed

 C

Latency present

 D

Suppressed by visual fixation

Q. 13

True about central nystagmus is:

 A

Duration not limited

 B

Direction fixed

 C

Latency present

 D

Suppressed by visual fixation

Ans. A

Explanation:

Q. 14

True about peripheral nystagmus is:

 A

Duration not limited

 B

Direction fixed

 C

No latency

 D

Vertigo not present

Q. 14

True about peripheral nystagmus is:

 A

Duration not limited

 B

Direction fixed

 C

No latency

 D

Vertigo not present

Ans. B

Explanation:

Q. 15

Stimulation of posterior semicircular canal produces

 A

Horizontal nystagmus 

 B

Pure vertical nystagmus 

 C

Pendular nystagmus

 D

Torsional vertical nystagmus

Q. 15

Stimulation of posterior semicircular canal produces

 A

Horizontal nystagmus 

 B

Pure vertical nystagmus 

 C

Pendular nystagmus

 D

Torsional vertical nystagmus

Ans. D

Explanation:

 

 

  • Superior semicircular canal lesion leads to torsional vertical upbeat nystagmus
  • Posterior semicircular canal lesion leads to torsional vertical downbeat nystagmus
  • Only vertical or horizontal nystagmus without torsion or only torsional without vertical and horizontal nystagmus is seen in central causes of nystagmus.

 

  • Medullary lesions lead to pure torsional nystagmus
  • Pure vertical nystagmus is seen in medullary lesion or vertebrobasilar insufficiency.
  • Pure horizontal nystagmus is seen in cerebral lesions.

Q. 16

In caloric test left jerk nystagmus occurs when:

 A

Cold water is poured in right ear

 B

Hot water is poured in right ear

 C

Cold water is poured in left ear

 D

All of the above

Q. 16

In caloric test left jerk nystagmus occurs when:

 A

Cold water is poured in right ear

 B

Hot water is poured in right ear

 C

Cold water is poured in left ear

 D

All of the above

Ans. A

Explanation:

Ans. Cold water is poured in right ear


Q. 17

In unilateral past pointing nystagmus the site of lesion is:

 A

Cerebellar hemisphere

 B

Lateral semicircular canal

 C

Flocculo-nodular lobe

 D

Superior semicircular canal

Q. 17

In unilateral past pointing nystagmus the site of lesion is:

 A

Cerebellar hemisphere

 B

Lateral semicircular canal

 C

Flocculo-nodular lobe

 D

Superior semicircular canal

Ans. A

Explanation:

Ans. Cerebellar hemisphere


Q. 18

Miners nystagmus is of which type:

 A

Lateral

 B

Vertical

 C

Rotatory

 D

Can be of any type

Q. 18

Miners nystagmus is of which type:

 A

Lateral

 B

Vertical

 C

Rotatory

 D

Can be of any type

Ans. C

Explanation:

Ans. Rotatory


Q. 19

Down beat nystagmus could be due to:

 A

Cerebellar lesion

 B

Arnold-Chiari malformation

 C

All of the above

 D

None of the above

Q. 19

Down beat nystagmus could be due to:

 A

Cerebellar lesion

 B

Arnold-Chiari malformation

 C

All of the above

 D

None of the above

Ans. C

Explanation:

Ans. All of the above


Q. 20

A patient has a right homonymous hemianopia with saccadic pursuit movements and defective optokinetic nystagmus. The lesion is most likely to be in the :

 A

Frontial lobe

 B

Occipital lobe

 C

Parietal lobe

 D

Temporal lobe

Q. 20

A patient has a right homonymous hemianopia with saccadic pursuit movements and defective optokinetic nystagmus. The lesion is most likely to be in the :

 A

Frontial lobe

 B

Occipital lobe

 C

Parietal lobe

 D

Temporal lobe

Ans. C

Explanation:

Ans. Parietal lobe


Q. 21

Brainstem dead are all, except:         

JIPMER 08

 A

Weaned off from ventilator, no respiration for 15 sec

 B

Absent pupillary response

 C

Absent nystagmus

 D

Absent corneal reflex

Q. 21

Brainstem dead are all, except:         

JIPMER 08

 A

Weaned off from ventilator, no respiration for 15 sec

 B

Absent pupillary response

 C

Absent nystagmus

 D

Absent corneal reflex

Ans. A

Explanation:

Ans.Weaned off from ventilator, no respiration for 15 sec


Q. 22

Illuminated frenzel glasses are used in detecting‑

 A

Nystagmus

 B

Heterophoria

 C

Esotropia

 D

Astigmatism

Q. 22

Illuminated frenzel glasses are used in detecting‑

 A

Nystagmus

 B

Heterophoria

 C

Esotropia

 D

Astigmatism

Ans. A

Explanation:

Ans. is ‘a’ i.e., Nystagmus

Illuminated frenzel galsses (+20 lenses) are useful for abolishing fixation and thus revealing peripheral vestibular nystagmus.



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