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  • 1.  Nystagmus after head trauma, but normal MRI

    Posted 6 days ago
    53 year-old man, who has developed nystagmus to the right after head trauma (fell from bike in 2023), most apparent on convergence and right gaze. Smooth pursuit to the right shows saccadic eye movements.
    Since the nystagmus is more pronounced upon right-gaze and convergence, he is very unhappy as he is required to do detailed work nearby for his job.
    MRI (at the time itself, but unsharp images and 2026) does not reveal any structural lesions.
    ENT/vestibular exam is unremarkable.
    Could I still explain this case by assuming the MRI is missing a small traumatic lesion or do you have a better suggestion?
    Michel


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  • 2.  RE: Nystagmus after head trauma, but normal MRI

    Posted 6 days ago
    Smooth pursuit to the right shows saccadic movement , is this a saccadic intrusion , square wave jerks , there different types , it would be really difficult to say without a video , but yes after traumatic ' Nystagmus' we can assume that image skipped a lesion , but does prisms cause any change in frequency , amplitude or trajectory?





  • 3.  RE: Nystagmus after head trauma, but normal MRI

    Posted 5 days ago
    Logic dictates there is a small lesion below the level of resolution in the brainstem. 

    Convergence and lateral gaze both can produce nystagmus in occasional cases and I have seen upper pontine and midbrain lesions bot hthat can produce gaze evoked nystagmus and convergence nystagmus. 

    Prof Owen B White MD PhD FNANOS FRACP
    Dept of Neurosciences
    Central Clinical School
    Monash University
    Melbourne, VIC, 3004
    Tel: _61 3 95760022
    Fax: +61 3 95760022
    Mob: +61 418822996
    Orcid ID: 00000-0002-2836-7344





  • 4.  RE: Nystagmus after head trauma, but normal MRI

    Posted 5 days ago
    Another possibility post traumatic is being functional , though not very common but also described in a similar fashion described here may be OKN pattern may give some clues 



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