Nystagmus: The Daily PANCE Blueprint

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Nystagmus: The Daily PANCE Blueprint

A 52-year-old patient with a history of alcoholic liver disease, chronic pancreatitis, and hyperlipidemia presents to the ER via EMS due to worsening mentation, an abnormal gait, and something “weird with his eyes.” On physical exam you notice his eyes twitch repetitively in a vertical manner. Which of the following is the most likely diagnosis?

A. Benzodiazepine overdose
B. Methamphetamine toxicity
C. Wernicke encephalopathy
D. Hepatic encephalopathy
E. Opioid withdrawal

Answer and topic summary

The answer is C. Wernicke encephalopathy

Nystagmus is defined as twitching, repetitive, and involuntary movement of both or one eye. There are several different types (torsional, mixed, horizontal, jerk, pendular, and vertical). Etiologies include vestibular neuritis, labyrinths, migraines, strokes, Wernicke’s encephalopathy, multiple sclerosis, phencyclidine (PCP), alcohol, sedatives, myasthenia gravis, etc. A classic test question is how Wernicke’s encephalopathy can cause gaze-induced horizontal/vertical nystagmus. It’s important to note that PURE downbeat, horizontal, or upheld nystagmus is almost nearly always due to a central lesion. A neurology referral/consult should be made.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint EENT ⇒ Disorders of the Eye ⇒ Neuro-ophthalmologic disorders => Nystagmus

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