Acute Nystagmus: Should We Worry? :

When a child presents with acute nystagmus, what’s in your differential diagnosis and should you be concerned? Garone et al (10.1542/peds.2020-0484) share with us the results of a retrospective look at children seen in pediatric emergency departments in nine hospitals in Italy over an 8-year period. The authors provide information on 206 children (mean age 8 years, 11 months) with acute nystagmus and used a logistic regression model to detect predictive variables that could be associated with a higher chance of the nystagmus flagging an urgent underlying condition. The authors found that nystagmus was frequently associated with headache and vertigo, with ataxia and strabismus being the most common neurologic signs. While more benign findings such as migraine and viral vestibular disorders were the most common causes of acute nystagmus, as well as idiopathic infantile nystagmus in children less than one, the authors also found that urgent conditions occurred in 18.9% of all cases with brain tumors being the most common urgent condition 8.3% of the time. The study identified three associated signs or symptoms suggestive of a more urgent etiology—cranial nerve problems, ataxia, and strabismus. The authors provide a lot more eye-opening information on this ophthalmologic finding so do more than just glance quickly at the findings. Link to the study and see what we mean.