Recordings documented that the pendular nystagmus that appeared clinically as uniocular was, in fact, present in both eyes but greater in the left eye. 17. Christopher M Bardorf, MD, MS is a member of the following medical societies: American Medical AssociationDisclosure: Nothing to disclose. 32:202-207. This website also contains material copyrighted by 3rd parties. and base-out prisms. Frontiers in Neurology. Matthew J. Thurtell Ocular oscillations are commonly encountered in clinical practice and can cause visual symptoms, such as oscillopsia, blurred vision, and difficulty reading. In our patient, the apparent uniocular pendular nystagmus exhibited the characteristics of an acquired, dissociated pendular nystagmus, perhaps caused by the subarachnoid hemorrhage in the neonatal period. acid (Lefkowitz and Harpold, 1985). Enrique Garcia-Valenzuela, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Retina Society, Society for NeuroscienceDisclosure: Nothing to disclose. Ann Indian Acad Neurol. MeSH Identification of nystagmus pattern is important in directing therapy and occasionally requires electronic eye movement recording for precise characterization. There are two types: congenital and acquired. The nystagmus shown below is from a patient with a pontine hemorrhage who also had oculopalatal myoclonus. vertical pendular nystagmus. In the recording above, an individual with high-frequency pendular was recorded looking to the side, with resulting cross coupling making it recordable. Journal of Neurology. 2007. Prognosis for cessation of the nystagmus is poor. Author L Averbuch-Heller 1 Affiliation 1 Departments of Neurology and Changes in the temperature and density of the endolymph due to the temperature of the irrigation water mimic those caused by rotations of the head. 81:1152-8. The https:// ensures that you are connecting to the Makhoul K, Ahdab R, Riachi N, Chalah MA, Ayache SS. WebAcquired Binocular Pendular Nystagmus Pendular nystagmus associated with a brainstem or diencephalic lesion Common causes: multiple sclerosis, brainstem/cerebellar tumor, 78:460464. Brain. HHS Vulnerability Disclosure, Help Archives of Ophthalmology. J Neurol Sci 375: 8-17. 1974 May;37(5):570-7 (1974). In the infantile (classical) onset form, death usually occurs in the second https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE5OTE3Ny1jbGluaWNhbA==. Therefore, the ipsilateral internuclear neurons must have fired, innervating the contralateral oculomotor neurons via the MLF, with concurrent inhibition of the ipsilateral abducens motoneurons. WebAcquired pendular nystagmus: Pendular nystagmus developing after infancy that may have horizontal, vertical, and torsional components. The patient, a boy, was the product of a 32-week gestation with a small subarachnoid hemorrhage noted by lumbar puncture performed in the nursery. WebAcquired pendular nystagmus is one of the more common types of nystagmus . A different version of this core idea, from the oculopalatal myoclonus literature, is that lesions of the CTT cause hypertrophy of the inferior olive, which may break into spontaneous oscillation. In the horizontal plane, the system was linear to 20 and monotonic (i.e., no reversal) to 2530 with a saturating characteristic. 15. [Full Text]. [Full Text]. Barton JJ, Cox TA. Pendular nystagmus is a type of oscillation. Lesions of the vestibulocerebellum and underlying medulla, including: Approximately 50% have no identifiable cause. Strabismusa necessary condition for latent and manifest latent nystagmus. . The room light could be adjusted from dim down to blackout to minimize extraneous visual stimuli. [36] The nystagmus response to caloric testing peaks 1 minute after the initiation of irrigation, falls to 50% after another 30-60 seconds and becomes minimal or disappears completely after one more minute. J Neurol Neurosurg Psychiatry 1993; 56:2627. An update with practical guidelines for ophthalmologists]. This patient had no horizontal movement in one eye, but both eyes had vertical pendular nystagmus. Schniepp R, Wuehr M, Huth S, Pradhan C, Schlick C, Brandt T, et al. Am J Case Rep. 2022 Jul 3;23:e935148. on the phase, the eyes may take on an oblique direction, forming a circle or an ellipse. We use the term congenital nystagmus (CN) to mean a conjugate nystagmus with characteristic pendular or jerk waveforms that are not normally related to strabismus or to the fixating eye (4). 1998. Tremor in Multiple Sclerosis-An Overview and Future Perspectives. -, J Neurophysiol. Deutsches Aerzteblatt Online. Please enable scripts and reload this page. Fetter, M. Assessing vestibular function: which tests, when?. The gait disorder in downbeat nystagmus syndrome. Strupp, M., Kremmyda, O., Adamczyk, C., et al. sharing sensitive information, make sure youre on a federal Hobson GM and others. Semin Ophthalmol. Pharmacological and Behavioral Strategies to Improve Vision in Acquired Pendular Nystagmus. Nystagmus of Pelizaeus-Merzbacher You are being redirected to Monocular occlusion resulted in the direction of the jerk nystagmus switching to that of the fixating eye. The frequency of the oscillation is set by the delay time. Anat Rec (New Anat) 2000; 261:15361. It appears that the normally strong yoking seen in humans, even those with strabismus, has been weakened sufficiently in this patient to reveal an innate ability in humans to make uniocular saccades, that is, to fire only the burst cells to the agonist extraocular muscle of one eye. The pendular nystagmus of spasmus nutans usually has a variable phase shift between the two eyes but is unaffected by saccades; this patient's interocular phase shift was either 45 or 135. Note the direction of OKN drum if it induces a change in nystagmus magnitude or direction. Follow this link for more detail. WebDisease or Syndrome. Zhou W, King WM. The usual age of onset is between 4 and 18 months of age. There are two main types of nystagmus: pendular and jerk. We used ocular motility recordings to identify the characteristics of a rare combination of conjugate, horizontal jerk, and pendular nystagmus in a 9-year-old boy. Then torsion "cross couples" into horizontal or vertical (vertical for lateral gaze, horizontal for vertical gaze). [Full Text]. In the later case, it is part of the syndrome of oculopalatal The absence of rapid deflections in the left eye velocity, acceleration, and jerk data verify that the leftward saccade in the right eye is uniocular. [Full Text]. Recording method: infrared video. While in supine, the patient elevates the head 30; this brings the horizontal semicircular canals into the vertical plane. [2] Asymmetry is abnormal, and the lesion can localize to the parietal-occipital cortex. Most frequently, horizontal pendular nystagmus is caused by central lesions involving Nystagmus duration after caloric irrigations. 2010 Dec 6;4:1409-22. doi: 10.2147/OPTH.S6383. In a patient with a negative oculocephalic reflex, the eyes remain at midline and do not move as the head rotates. LEHV/50 +# is the left-eye velocity divided by 50 and shifted by the amount shown (for clarity). 1980 Mar;103(1):23-69 Epub 2021 Oct 19. Gresty, M., Ell, L., & Findley, L. cquired pendular nystagmus: Its characteristics, localising value and pathophysiology. [Full Text]. Conversely, if the second corrective movement is slow, the nystagmus is termed pendular nystagmus and is commonly characterized with sinusoidal oscillations Symposium. 82:1380-1. (1996). 234-236. 45:431-439. WebThe most common causes of acquired pendular nystagmus (APN) are multiple sclerosis (MS) and oculopalatal tremor (OPT), both of which result in poor visual quality of life. Oculocephalic reflex (dolls head phenomenon). The first video segment shows minimal to no movement in the right eye and Since the pathological oscillations are embedded in normal eye movements, such a device must WebInvestigations were made of 16 patients with acquired pendular nystagmus and a further 32 cases reported in the literature were reviewed. The .gov means its official. Hain, T. C. and M. Cherchi (2008). Gold, D. R. Liu, Volpe, and Galettas Neuro-Ophthalmology. Thurtell, M.J., Leigh, R.J. There were no characteristic CN waveforms, although the presence of a conjugate, high-frequency pendular nystagmus superimposed on the jerk is common in both CN and LMLN. FOIA 2021 Jul-Aug;47(4):747-752. doi: 10.1590/S1677-5538.IBJU.2021.99.06. [Full Text]. 1B) during LN (one eye occluded) and of the right eye (Fig. Aschoff, J. C., et al. 7. two pendular axes at the same time, so the eye traces out an ellipse) Dissociated pendular nystagmus (i.e. Traccis S, Rosati G, Monaco MF, Aiello I, Agnetti V. Successful treatment government site. Associated deafness or tinnitus suggest peripheral lesions of the vestibular system. 21; Using the Titmus test, we confirmed that there was no stereopsis. -, Brain. Federal government websites often end in .gov or .mil. Torsional Elliptical (i.e. Asymmetrical nystagmus can also be seen when the vergence system is involved Neuroophthalmology 16(2): 107-113. Upbeat and downbeat nystagmus occurring successively in a patient with posterior medullary haemorrhage. This seems a little more likely than the first idea. 2/GLOSSary (cont'd) As my old Chief Robert Joynt advised: 2. Rather than formulating the problem in terms of neurons sending signals in a loop with a delay, there are also a physiology involved with oscillations called "gap junctions" (Juszcak et al, 2009). Disclaimer. Graefe's Archive for Clinical and Experimental Ophthalmology. Objective: Acquired pendular nystagmus occurs mainly in multiple sclerosis (MS) and focal brainstem lesions. Acquired pendular nystagmus 1995 Apr;119(4):489-96 Neurology 1986:36:82-84. 1. This site needs JavaScript to work properly. J Neuroophthalmol. "Pulse-synchronous torsional pendular nystagmus in unilateral superior canal dehiscence." Kim JS, Choi KD, Oh SY, Park SH, Han MK, Yoon BW, Roh JK. There are two types: congenital and acquired. 2008 Jun 3. 19:6-14. 1969. The MRI cuts at the medullary, pontine and midbrain levels were analysed statistically to determine the areas where there was significant (< 0.05%) overlap between areas of abnormal signal in different patients. Curr Opin Neurol. The reflex develops at about age 6 months and is produced as the patient pursues a moving object, while maintaining a stationary head position, and then experiences a corrective saccade in the opposite direction to follow the next moving target. The https:// ensures that you are connecting to the In Cockayne's Acquired pendular nystagmus is comprised of quasi-sinusoidal oscillations of the eyes significantly affecting gaze holding and clarity of vision. [Full Text]. There are two types of nystagmus. That schema would allow an ipsilateral, uniocular, abducting saccade. 1994. This condition can also cause purely torsional pendular nystagmus, which is recognized by being synchronized to the pulse. age, or acquired later in life. Large recession of the four vertical rectus muscles for acquired pendular vertical nystagmus and oscillopsia without a null zone. Section 5: Neuro-Ophthalmology. 2001. Data analysis (and filtering, if required) and graphical presentation were performed using MATLAB (The MathWorks, Natick, MA) software for scientific computing. [Full Text]. that frequently appears after pontine hemorrhage. Clipboard, Search History, and several other advanced features are temporarily unavailable. An instance of spasmus nutans presenting with monocular nystagmus in monozygous twins has been reported. If this is true, one would think that it could oscillate more quickly than 1 hz (i.e. Educational use is permitted. Curr Treat Options Neurol. Caloric testing is used to assess the function of the peripheral vestibular system and involves up to four irrigations of water or air into the external ear meatus. 1:1101-67. Association for Research in Vision and Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, North American Neuro-Ophthalmology Society, Royal College of Physicians and Surgeons of Canada, Microvascular disease with vertebrobasilar insufficiency, Tumors at the foramen magnum (eg, meningioma, cerebellar hemangioma), Drugs (eg, alcohol, lithium, antiseizure medications), Nutritional (eg, Wernicke encephalopathy, parenteral feeding, magnesium deficiency). Chen YR, Fredrick D, Steinberg GK, Liao YJ. for: Medscape. [Full Text]. Based on pathophysiological hypothesis, pharmacological treatments of acquired nystagmus have been thoroughly proposed over different publications of cases, series, reviews or expert 2002 Nov. 16:804-6. The most common causes of acquired pendular nystagmus include demyelinating disorders such as multiple sclerosis and the syndrome of ocular palatal tremor. This site needs JavaScript to work properly. Wolters Kluwer Health and transmitted securely. JAMA: The Journal of the American Medical Association. Don't forget to look up at the soft palate. Acuity and the presence of INO were unrelated to the conjugacy of the nystagmus. Introduction Evaluation of the infant or child with infantile nystagmus syndrome (INS) is very challenging because INS can be an isolated abnormality or appear in association with a wide variety of underlying visual sensory and systemic disorders. WebNystagmus can affect both children and adults. Nystagmus is an involuntary, rhythmic ocular movement that is initiated by a slow drift and comes in two varieties (Fig. The most common causes of acquired pendular nystagmus include demyelinating disorders such as multiple sclerosis and the syndrome of ocular palatal tremor. Tusa et al. Please enable it to take advantage of the complete set of features! It is inferred that the mechanism responsible for the pendular nystagmus lies at a level which is close to the oculomotor nuclei so that it can have monocular effects but is not part of the primary motor pathways. For example, this can occur after a pontine hemorrhage. of 600-1500 mg/day (Stahl et al, 1996). Uniocular square-wave jerks also were recorded. The congenital and see-saw nystagmus in the prototypical achiasma of canines: comparison to the human achiasmatic prototype. Perverted head-shaking nystagmus: two possible mechanisms. Follow this link to read more. in toluene addiction. The wiring issue is very interesting. Unlike congenital pendular nystagmus, acquired pendular nystagmus often entails slow-phase eye movements in horizontal, vertical, and torsional planes with resultant elliptical or circular nystagmus. Gaze-stabilizing deficits and latent nystagmus in monkeys with brief, early-onset visual deprivation: role of the pretectal NOT. 1C) during MLN (both eyes viewing). Congenital, latent and manifest latent nystagmussimilarities, differences and relation to strabismus. Curr Treat Options Neurol. In patients with latent nystagmus, acuity should be measured by fogging the contralateral eye with a hyperopic lens. Kerkeni H, Brgger D, Mantokoudis G, Abegg M, Zee DS. Would you like email updates of new search results? Straube, A., Bronstein, A., & Straumann, D. Nystagmus and oscillopsia. Optokinetic or pendular nystagmus- multi-direction (e.g.vertical, torsional, or horizontal) nystagmus in response to moving or rotating visual fields or objects, the slow phase is ipsilateral to the visual stimuli, and it does not have a fast phase. Elliptical (i.e. Spasmus nutans is a transient pendular nystagmus that In spite of these sporadic reports of success, we have not had much success ourselves. Lesions of the central tegmental tract (such as due to MS), Spasmus Nutans (can also be vertical, torsional). PMID: 11096697 DOI: 10.1007/s11940-999-0034-4 Neurology 1990:40. The data were digitized at 500 Hz with 16-bit resolution. Neurology. The further the drum is from the patient, the better the visual acuity must be to respond normally to the moving drum. we are dubious). Rousseaux M, Dupard T, Lesoin F, Barbaste P, Hache JC. The doses are relatively massive (1 mg-60 mg), precluding use in Gresty, M. A., et al. Investigative Ophthalmology & Visual Science. Its pathogenesis remains unclear, and more than one mechanism may be responsible for its FOIA Refractive changes with post-rotatory nystagmus in healthy individuals. leukodystrophies, only Cockayne's syndrome has a similar nystagmus. There was a conjugate, horizontal jerk-right nystagmus with a left face turn and a constant, apparently uniocular, horizontal pendular nystagmus in the left eye that was clinically compatible with spasmus nutans. Data is temporarily unavailable. Eye. one eye doing something different The clinical diagnoses were amblyopia, left esotropia, congenital nystagmus, and an apparently uniocular pendular nystagmus that mimicked spasmus nutans. REH, right eye horizontal; LEH, left eye horizontal; us, uniocular saccade; rightward eye movements are positive. Persons with complete blindness as well as retinal dystrophies that may preserve some vision of ten exhibit nystagmus. treated with INH (200 mg BID to QID, with pyridoxine) combined with converging References re. DN is a nystagmus where oscillations differ in direction or amplitude between two eyes. J Neurophysiol 2001; 86:66275. 95:231-234. 1987. Is acquired pendular nystagmus always phase locked? HHS Vulnerability Disclosure, Help In pendular nystagmus, the eye motion is like a pendulum swinging back and forth. Thus, the current putative neuroanatomy whereby a single pool of burst neurons drives both eyes for ipsilateral saccades is, at best, inadequate and possibly incorrect. 11. The rightward saccade that followed at 19.8 seconds was so dissociated (much greater in the left eye) that it was almost uniocular. Oscillations are generally caused by feedback loops. [Full Text]. [Full Text]. Central Oculomotor Disturbances and Nystagmus. The so-called "ocular myoclonus" associated with the oculo-palatal Some congenital nystagmus patients have mainly a torsional pendular nystagmus. J Vestib Res 1994; 4:33545. The most common causes In each case, the jerk nystagmus is in the direction of the fixating eye, a characteristic of latent/manifest latent nystagmus (LMLN). Seesaw nystagmus may be caused by the following: Downbeat nystagmus may be caused by the following: Upbeat nystagmus may be caused by the following: Periodic alternating nystagmus may be caused by the following: Pendular nystagmus may be caused by the following: Spasmus nutans may be caused by the following: Abducting nystagmus of internuclear ophthalmoplegia may be caused by the following: Gaze evoked nystagmus may be caused by the following: Panthagani, J., Virdee, J., MacDonald, T., et al. A left face turn was present when he fixated on a distant target. Central ocular motor disorders, including gaze palsy and nystagmus. -, Ann Neurol. Because these saccades appeared in a subject with strabismus during fixation of an LED with no vergence stimuli, it is unlikely that they were due to superimposed vergence signals. WebAcquired Binocular Pendular Nystagmus Pendular nystagmus associated with a brainstem or diencephalic lesion Common causes: multiple sclerosis, brainstem/cerebellar tumor, stroke, hemorrhage, inflammation Uncommon causes: neurodegenerative states, Pelizaeus-Merzbacher disease, Whipple disease, chiasmal or thalamo-mesencephalic lesion, albinism J Neurol Neurosurg Psychiatry. Pendular nystagmus is a sinusoidal oscillation, which refers to the waveform of involuntary eye movements that may occur in any direction. For example, it only takes about 200 msec response time for rather complex reactions (i.e. Another possibility is that the uniocular saccades resulted from vergence burst neurons. With intact vestibular nuclei and medial longitudinal fasciculi, the eyes move conjugately in the opposite direction of the head turn. has a pendular waveform, is of low frequency and small amplitude. A reversed Alexander law has been reported in some cases of LMLN (3). The inferior olive may be responsible for the rhythm of ocular oscillation. Pendular nystagmus is generally due to either loss of inhibitory feedback control on a neural circuit, or increased delay in a feedback circuit, that then breaks into spontaneous oscillation. Herishanu Y, Louzoun Z. Trihexyphenidyl treatment of vertical pendular nystagmus. [36] Caloric irrigations create a thermal gradient, or a temperature difference, between the external auditory canal and the endolymph in the horizontal semicircular canal of the inner ear, which in turn changes the density of the endolymph causing it to rise or sink (depending on the temperature of the irrigation fluid). If pharmacologic therapy fails, optical devices can be considered in selected patients. An official website of the United States government. Timothy August 1, 2022, Below is a short movie of pendular nystagmus in the author's partially abino cat. Head Nodding is Compensatory in Spasmus Nutans. Horizontal eye movement recordings were made using infrared reflection (Applied Scientific Laboratories, Waltham, MA). 2008 Mar-Apr. Ann NY Acad Sci 2002; 956:34660. Curr Neurol Neurosci Reports. prisms. 1:471-7. Enrique Garcia-Valenzuela, MD, PhD Clinical Assistant Professor, Department of Ophthalmology, University of Illinois Eye and Ear Infirmary; Consulting Staff, Vitreo-Retinal Surgery, Midwest Retina Consultants, SC, Parkside Center Don't forget to look up at the soft palate. Chiasmal, suprachiasmal, or third ventricle gliomas may cause a condition that mimics spasmus nutans. 2) revealed damping with abduction of the fixating right eye, opposite to that predicted by Alexander law. Damping of monocular pendular nystagmus with vibration in a patient with multiple sclerosis. Please enable it to take advantage of the complete set of features! Eye movements in canine hemichiasma: does human hemichiasma exist? Unable to load your collection due to an error, Unable to load your delegates due to an error. For more information, please refer to our Privacy Policy. Jerk nystagmus, the more common type, is characterized by eyes that drift slowly in one direction and then jerk back the other way. Age of onset of the nystagmus, whether it is constant or intermittent, the presence of any aggravating or alleviating factors (eg, head or body positions). Eye positions and velocities (obtained by analog differentiation of the position channels) were displayed on a strip chart recording system (Beckman Type R612 Dynograph). High-frequency pendular nystagmus is known to accompany LMLN and CN, and may be associated with poor vision. The .gov means its official. "Acquired pendular nystagmus with oscillopsia in multiple sclerosis: a sign of cerebellar nuclei disease." The waveform of pendular nystagmus may occur in any direction; it can be torsional, horizontal, vertical, or a combination of these, resulting in circular, oblique, or elliptical trajectories. The sensitivity was 0.25. We find this theory very hard to follow, and in general prefer the neural syncytium theory. Acquired Pendular Nystagmus in Multiple Sclerosis Legend: Video shows acquired pendular nystagmus in a patient with multiple sclerosis. We are grateful to Dr. Brian Mohney for allowing us the opportunity to study this unusual patient. There is no diplopia because vision in the deviated eye is suppressed. Mutations in nocoding regions of the proteolipid progein Dell'Osso LF, Daroff RB. Sometimes a horizontal and vertical pendular nystagmus will occur together. the central tegmental tract. Please confirm that you would like to log out of Medscape. J Neurol Neurosurg Psychiatry. Trials were kept short to guard against boredom because CN intensity is known to decrease with inattention. In cases of binocularity, a yoking mechanism coordinates the firing of both subgroups of burst cells so that conjugate saccades result. 1992. There are many drugs that affect gap junctions, mainly relatives of quinine, that may have a role in suppressing pendular nystagmus. Gregory Van Stavern, MD Attending Physician, Department of Ophthalmology and Neurology, Washington University School of Medicine [Full Text]. An extremely rare inherited disorder, Alexander's disease, also includes ocular palatal tremor (Kang and Shaikh, 2017), and presumably shares the same general pathophysiology. 14:6072. European Journal of Neurology. Gottlob, I., & Reinecke, R. D. Spasmus nutans. Accessibility WebAcquired Pendular Nystagmus. A horizontal nystagmus due to peripheral vestibular imbalance remains horizontal on upward and downward gaze. Brain. Huy D Nguyen, MD, MBA Resident Physician, Department of Ophthalmology, University of Texas Health Science Center at San Antonio School of Medicine Rinsho Shinkeigaku. Analysis of the data from such cases may also provide insight into the organization of the ocular motor system. The most common causes of acquired pendular nystagmus include demyelinating disorders such as multiple sclerosis and the syndrome of ocular palatal tremor Acquired pendular nystagmus Downbeat nystagmus from heat stroke. antibiotics). Vision Res 1995; 35:10916. The OKN drum may be used as an estimate of visual acuity. 1987 May;37(5):887 Infrared eye movement recording. Language links are at the top of the page across from the title. That is, jerk-right CN increases with rightward gaze and jerk-left CN increases with leftward gaze. Some patients with oculopalatal myoclonus have mainly a torsional nystagmus. The rapid deflections in the velocity, acceleration, and jerk data of both eyes confirm these simultaneous, albeit disjunctive, saccades. Congenital nystagmus waveforms and foveation strategy. The optokinetic reflex allows us to maintain foveation on a moving object when the head is stationary (ex., observing individual telephone poles on the side of the road as one travels by them in a car). described in spasmus nutans (see above), congenital nystagmus, and various brainstem disorders, Neurology 2000:55:1089-1096, Keane JR. It may consist of alternating phases of a slow drift in one direction with a corrective quick "jerk" in the opposite direction, or of slow, sinusoidal, "pendular" oscillations to and fro. Central oculomotor disturbances and nystagmus: a window into the brainstem and cerebellum. Weissman BM, Dell'Osso LF, Abel LA, et al. Persons with CN often combine visual issues and "wiring" problems. Pharmacological tests of hypotheses for acquired pendular nystagmus. Neural control of ocular motor systems. 1989. 261:542558. OKN is involuntary but may be suppressed if the patient looks above or below the moving object. WebAcquired pendular nystagmus, one of the more common and debilitating types of nystagmus, is characterised by a spectrum of horizontal/vertical quasi-sinusoidal movements. From the Ocular Motor Neurophysiology Laboratory (JIK, LFD), Veterans Affairs Medical Center; the Department of Neurology (LFD), Case Western Reserve University and University Hospitals of Cleveland; Cleveland, Ohio; the Department of Neurology, Dankook University, Cheonan, Korea (JIK); and the Department of Pediatric Ophthalmology and Strabismus, Cleveland Clinic, Cleveland, Ohio (ET). Aring, E., Grnlund, M. A., Hellstrm, A., et al. While a fairly typical pendular nystagmus might have a period of 1 second, in the brain, most of the delays are much shorter than 1 sec. C. Hain, MD Page last modified: Strupp, M., Hfner, K., Sandmann, R., et al. The most common cause of vertical pendular nystagmus is the vertical nystagmus
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acquired pendular nystagmus
