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Unilateral Pendular Nystagmus in Multiple Sclerosis: A Case Series
Amir R Vosoughi1, Natalie Brossard Barbosa, Jonathan Micieli
1Max Rady College of Medicine (ARV), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Ophthalmology and Vision Sciences (NBB, JM, EM), University of Toronto, Toronto, Canada; and Division of Neurology (JM, EM), Department of Medicine, University of Toronto, Toronto, Canada.
Monocular pendular nystagmus, often linked to multiple sclerosis, can cause debilitating vision issues. Memantine treatment showed promise for improving symptoms in affected patients.
Area of Science:
- Neuro-ophthalmology
- Neuroscience
- Clinical Neurology
Background:
- Acquired pendular nystagmus typically indicates demyelinating disease, but monocular cases are rare.
- Limited data exists on the clinical presentation, mechanisms, and treatment of monocular pendular nystagmus.
Observation:
- A case series of 5 patients with monocular pendular nystagmus diagnosed with multiple sclerosis.
- Nystagmus varied (horizontal/vertical), visual acuity ranged from 20/20 to 20/200, and oscillopsia was reported in 3 patients.
- Nystagmus correlated with worse visual acuity in 80% of cases, often associated with pontine lesions.
Findings:
- All 5 patients had multiple sclerosis; 3 experienced debilitating oscillopsia.
- Memantine treatment was effective in 2 symptomatic patients.
- Asymmetrical brainstem lesions and afferent visual input are potential causes.
Implications:
- Monocular pendular nystagmus in adults is strongly associated with multiple sclerosis.
- This condition may result from asymmetric neurological damage.
- Memantine offers a potential therapeutic option for symptomatic individuals.
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