Quix ~ Question about Nystagmus

[6-paq]

I had a VNG in June due to dizziness.

Results were:

CNS testing was unremarkable.

Positional testing was negative for nystagmus in all head and body positions, except for head hangling.

Dix-Hallpike was negative for rotational/torsional nystagmus in both head positions.

Caloric testing did reveal a significant unilateral weakness for right ear and significant directional preponderance.

Head Hanging:  Mild left beating nystagmus
Unilateral Weakness: right ear 77%  preponderance to left

I went to a new PCP office today and saw a Nurse Practioner that tested me for nystagmus.  She said that I have bilateral lateral nystagmus of 2-3 beats.  

Does the bilateral lateral nystagmus indicate more of a CNS (therefore MS) cause?  I'm reading about BINO ~ is this "BINO"?   I've also read that 96% of those with BINO are diagnosed with MS.

Does this finding significanly differ from the VNG results I had only 4 months ago?   When I look at the VNG results, I do not find any reference to a "right beating nystagmus", just a left beating.

Sooooooo....  I'm guessing that if the NP is correct,and my neuro can confirm this, then this may be one step closer to getting that diagnosis.

Also, this NP was the first person who actually listened for a "bruit" (she didn't hear one BTW).  I was very suprised as I've told 5 different MDs about my "pulsatile tinnitus" and none of them have checked for a bruit. ;-)   She also ran some blood tests that I haven't had run before (c-reactive protein, thyroid panel, RPR, metabolic panel.).  Got a referral to a Balance Center and a Rheumatologist.

[6-paq]

Thanks so much for this info (and for explaining it)!!!  

Hmmm.... I have no double vision and I don't feel my eye jerking at all, so it came as a big surprise.  It is something that I will definitely need to look into, and does have me worried a bit.

Thanks again ladies!!  Take care!   Pat :)

[T-lynn]

I'm glad your webstering is working today as my brain and vision aren't functioning well.

As always you have just put everything into normal terms.

Thanks

[Quixotic1]

DEFINITIONS FOR THE POST ABOVE

Primary gaze - simply looking straight ahead

Abduction - To abduct or take away (kidnap)  away from the center

Right eye - look toward the right ear
Left  eye  - look to the left ear

Adduction -  Bring to the center  -(extreme adduction - pull the eye completely in toward the nose)

R eye - look toward the nose
L eye  - look toward the nose

Diplopia - double vision

horizontal diplopia - If you look laterally there will be two images side-by-side (arranged horizontally)

Adduction deficit - be unable to move the eye as far as needed inward toward the nose

Nystagmus - a "beating" back and forth with a slow movement, and a fast return

Medial Rectus palsy - weakness of the eye muscle which pulls the eye inward toward the nose

Converge - Bring both eyes inward (like corss-eyes)  If you stare at an object at arm's length and slowly move it directly toward the face both eyes will stay focused on it and they will both move inward - converge.

Quix Webster

[T-lynn]

Some info I found

INTERNUCLEAR OPHTHALMOPLEGIA
SIGNS AND SYMPTOMS
Several underlying systemic diseases can cause this condition. There is a painless onset of visual disturbance, but often no diplopia in primary gaze. There will be horizontal diplopia in lateral gaze. The patient will manifest an adduction deficit on the involved side and a nystagmus of the fellow eye in extreme abduction.

Occasionally, the condition is bilateral with medial rectus palsy and adduction deficit in each eye and nystagmus upon abduction in both eyes (bilateral internuclear ophthalmoplegia, or BINO) While there appears to be medial recti palsy, most patients will be able to converge (posterior INO or BINO). In some cases, the patient will not be able to converge (anterior INO or BINO).



T

[T-lynn]

I drive still,I do have terrible time reading and tracking with my eyes.When I look to yhe left I can feel that eye bounce back and forth.

I have double vision quite often.

Theres not much theu can do for it.I try to ignore it.

I'll write more in detail when I can get it together,med changes and I'm loopy.

T

[6-paq]

Thanks Quix!!  I'll be sure to let them know!!   They do know about the "possible MS" already.

Take care and have a great evening!!  Pat :)

[Quixotic1]

Yes, it can wait until after your surgery.  But the anesthesisologist should know you've been having nystagmus so if they see it after anesthesia they don't think something happened during surgery.  okay?

[Quixotic1]

Yes, the otoneurologist is also a perfect solution!  Q

[6-paq]

Thanks T!

I've also read that INO/BINO is caused by the CNS.

I'm a bit confused about the tests.  I had a VNG with goggles.  There were no electrodes.  I looked at images projected on a wall for part of the testing, then positional stuff and the Caloric portion.  The CNS was "normal" during the testing.  The Caloric portion showed the vestibular weakness, thus indicating a peripheral problem. This was back in June.

I also had a VEP with electrodes and looking at a computer screen.  This was in August.  That was normal also.

So, I am unsure as to what the NP saw.????   I had my 15 yo son look at my eyes when I gazed to the left and right and he saw my eye jump a couple of times.  He said it was horizontal movement and wasn't that strong.

I believe there is a neurotologist that runs the Balance center where the NP referred me.  I'll have to double check on that.

What side effects do you experience with the INO/BINO?  Is it very debilitating (i.e., are you unable to drive with it).   I was actually surprised by the findings today, as I have not had any double vision or that type of problem.  I have been experiencing a bit of frequent "visual drunkeness" that happens when my headaches are more intense.  But, that always happens in a pretty predictable timeframe (within an hour after I awake and goes away by mid-afternoon).    Is this what you experience??

Thanks for your help!!!  Pat :)

[T-lynn]

I have INO/BINO

Mine was dx'd through a VNG that effected the central nervous system.

To my understanding which I could be wrong is that INO/BINO comes from the cns.

Nystagmus can also be caused peripherial

Try to see a neurOtologist----neuro ENT as my INO/BINO was not discovered by neuro-opthamologist nor through a VEP.

If you can't get into a neurOtologist ask if you can send the report and the VNG print out or a copy of the cd test to them for a reveiw.

The VNG is a evoked potential to differerate dizziness to be either central nervous system or peripherial

Was yours done with the googles and a couple electrodes to the head and a computer screen or just electrodes pasted every where with a paper print out.It does make a difference.

Hope this offers you some help,I'm half loopy tonight.

T

[6-paq]

Ughhh.....  not what I wanted to hear... and I'm getting a bit scared :(

I was sitting on an exam table.  I had just finished my PT about 10 minutes before that (where I was hanging my head doing leg/back exercises)...

I have surgery coming up on Wednesday (endoscopic sinus), so how critical is it that I get to a neuro-ophthalmologist quickly?  I believe there are only 2 in the entire San Diego county, if that, so I don't know how fast I could even get in.

Would this be something that can wait until after my surgery?   Is it something that either my regular neuro or ophthalmologist needs to be apprised of immediately?  Would this signify something other than MS?

Thanks so much for your quick reply!  I hope you are feeling well!!
Take care!  Pat :)

[Quixotic1]

What position were you in when the nurse saw the nystagmus?  If you were simply vertical and had not been whirling around or having your head turned and rotated (picture Meryl Streep in "Death Becomes Her") then this is a significant change from the VNG.  I would say you need a referral ASAP to a neuro-ophthalmologist.  I'm lucky - my MS neuro is also a neuro-ophthalmologist.

I would have to read again about BINO to see how it presents.  Lynn has it, so she could likely tell you.

Quix.