Spasmus nutans: a mistaken identity

Three patients around the age of 1 year had signs and a clinical course that suggested the diagnosis of spasmus nutans. One child had nystagmus and head nodding with normal fundi, but persistent failure to thrive that suggested a hypothalamic lesion from the onset. The second child had nystagmus, head nodding, and a head tilt, and a confident diagnosis of spasmus nutans was made. The third child had unilateral nystagmus with no other abnormalities, and when improvement occurred, spasmus nutans was throught to be the most likely diagnosis. All three patients had tumors that involved the third ventricular region and optic chiasm.