Abstract

Introduction: Nystagmus is a rhythmic regular oscillation of the eyes. In this case series, we present four cases who presented to the emergency department different clinical complaints and had nystagmus on examination.

Methodology: The patients presented to the D.Y. Patil Medical College & Hospital, Navi Mumbai, India with varied clinical presentations and on ophthalmologic examination had nystagmus. The data presented in this article were obtained from the retrospective review of the medical records of the patient.

Results: One patient, recently diagnosed with seizure disorder, presented with decreased vision and slurred speech. Horizontal nystagmus with fast component to the left was observed on ophthalmologic examination and serum phenytoin levels were more than 40 mg/ml. Final diagnosis of phenytoin diagnosis was made. One hypertensive patient with giddiness and loss of balance presented with blood pressure of 170/100 mm Hg. Vertical nystagmus with positive Romberg sign was noted. Magnetic Resonance Imaging (MRI) revealed an infarct on the right hemi-pons. Another patient with no significant past medical history presented with headache, slurred speech and blurred vision. Nystagmus and impaired cerebellar signs were noted. MRI revealed an infarct in the right middle cerebellar peduncle. Last patient with history of hypertension had ptosis, opthalmoplegia and vertical nystagmus, who had an ischemic stroke of ventromedial portion of bilateral thalami and peri-aqueductal grey matter.

Conclusions: Nystagmus can present with various clinical conditions. Eliciting relevant past medical history, understanding present illness in detail and correlating with laboratory and imaging studies is necessary to make a correct and timely diagnosis.

Keywords: Seizure; Stroke; Nystagmus.