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Spasmus Nutans

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1 Spasmus Nutans on Tue Oct 13, 2009 7:21 am

TJW

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Definition:

Spasmus nutans is a disorder affecting infants. It involves rapid, uncontrolled eye movements, head bobbing, and occasionally, abnormal positioning of the neck.

Causes, incidence, and risk factors:

Spasmus nutans involves a triad of symptoms which includes horizontal, vertical, or pendular nystagmus (fine, rapid jerking of the eyes back and forth, and from side to side), head nodding, and head tilting.

Most cases begin between age 4 months and 1 year. It usually goes away by itself in several months to years. Less commonly it may be associated with other causative conditions. Rarely, symptoms like those of spasmus nutans may be produced by tumors in the optic chiasm or third ventricle of the brain.

Symptoms:

•Nystagmus (fine, rapid jerking of the eyes from side to side)
•Head nodding
•Head tilting

Signs and tests:

A neurologic examination confirms the presence of the symptoms.

Tests may include

•CT scan of the head
•MRI scan of the head

Treatment:

The benign form of spasmus nutans requires no treatment. Other conditions causing spasmus nutans must be treated individually.

Expectations (prognosis):

Usually, this disorder goes away on its own without treatment.

Complications:

There are usually no complications.

Calling your health care provider:

Call for an appointment with your health care provider if your child has nystagmus, head nodding, or other symptoms (to rule out causative conditions such as tumors).

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TJW

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A case of spasmus nutans was studied using objective recordings of head and eye displacement in order to generate a precise description of the ocular oscillations and head nodding and to investigate their interrelationships. The ocularoscillations consisted of 11-Hz sinusoidal convergence movements. The head nodding consisted of a 3-Hz, 3 degrees peak to peak, sinusoidal oscillation in the horizontal plane. The occurrence of the nodding always abolished the ocular oscillation which was replaced by normal compensatory eye movements which assisted visual acuity. The hypothesis is made that the head nodding is not pathological; it is a learned behavioural pattern which permits the patient to nullify the pathological eye movements. In order to test this hypothesis further, objective evidence is required to determine the precise order of appearance of the abnormal head and eye movements in spasmus nutans.

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3 Spasmus Nutans A Benign Clinical Entity? on Tue Oct 13, 2009 7:59 am

TJW

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Spasmus nutans occurs in early childhood and consistsof a triad of symptoms as follows: small-amplitude, rapid, horizontalnystagmus in one or both eyes asymmetrically; head nodding;and anomalous head position. Once thought to be a benign clinicalentity, there are an increasing number of reports linking spasmusnutans to optic nerve and chiasmal gliomas. We describe 14 patientswith spasmus nutans, none of whom were found to have a tumorwith computed tomographic scanning. One patient, however, hadan arachnoid cyst and an empty sella and another patient hada porencephalic cyst. The diagnosis of spasmus nutans, its implications,and its management are discussed.

Robert A. King, MD; Leonard B. Nelson, MD; Rudolph S. Wagner, MD

From the Department of Pediatric Ophthalmology, Wills Eye Hospital, Philadelphia (Drs King and Nelson), and the Department of Ophthalmology, University of Medicine and Dentistry of New Jersey, Newark (Dr Wagner).

Full Case Study available at http://archopht.ama-assn.org/cgi/reprint/104/10/1501 (PDF Format, takes a short while to automatically download the information to your web browser).

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