Downbeat Nystagmus

A patient was referred with double vision and oscillopsia. He reported to have nystagmus and oscillopsia for a few years, and recently mild worsening. He denies head trauma, weakness, numbness, changes in his vision, transient visual loss, or headache. Patient has trouble reading with progressive glasses due to having to look down to reach near add and experiencing oscillopsia. Past medical history and past surgical history was positive with HTN, hypercholesterolemia, melanoma in his back (was removed 3 years ago), SCC in the back of his head (was removed 2 years ago). In examination, patient BCVA was 20/20 in both eyes. In external exam he had small angle esotropia and jerky nystagmus, enhanced in lateral gaze and down gaze and dampened in up gaze. With diagnosis of downbeat nystagmus brain MRI was ordered. As brain MRI was normal, Lab tests including paraneoplastic panel and celiac disease comprehensive panel was requested and both were negative. With diagnosis of idiopathic downbeat nystagmus, baclofen 5 mg BD was started. At last exam, the amplitude and frequency of nystagmus was diminished. He reported improved ability of reading and easier to move around since on baclofen. He tolerated baclofen well.

Presentation Date: 01/12/2023

Issue Date: 01/20/2023