Pediatric patients are commonly referred to imaging following abnormal ophthalmological examinations. Common indications include papilledema, altered vision, strabismus, nystagmus, anisocoria, proptosis, coloboma, and leukocoria. Magnetic resonance imaging (MRI) of the brain and orbits (with or without contrast material administration) is typically the imaging modality of choice. However, a cranial CT scan is sometimes initially performed, particularly when MRI is not readily available. Familiarity with the various ophthalmological conditions may assist the radiologist in formulating differential diagnoses and proper MRI protocols afterward. Although MRI of the brain and orbits usually suffices, further refinements are sometimes warranted to enable suitable assessment and accurate diagnosis. For example, the assessment of children with sudden onset anisocoria associated with Horner syndrome will require imaging of the entire oculosympathetic pathway, including the brain, orbits, neck, and chest. Dedicated orbital scans should cover the area between the hard palate and approximately 1 cm above the orbits in the axial plane and extend from the lens to the midpons in the coronal plane. Fat-suppressed T2-weighted fast spin echo sequences should enable proper assessment of the globes, optic nerves, and perioptic subarachnoid spaces. Contrast material should be given judiciously, ideally according to clinical circumstances and precontrast scans. In this review, we discuss the major indications for imaging following abnormal ophthalmological examinations.

Neuroimaging in Children with Ophthalmological Complaints: A Review.

Ictal nystagmus is a rare phenomenon secondary to an epileptic seizure, usually in the temporo- occipital region. For its characterization, we must rely on clinical history, examination, and ideally observation of the episodes.


OBJECTIVES
To describe a case of this unusual entity and highlight the characteristics that should increase diagnostic suspicion in order to avoid treatment delay.


CLINICAL CASE
An 8-year-old schoolboy, with no relevant history, consulted due to 5-6 episodes a day in the last year of conjugate horizontal eye movements with rapid jerks and associated slight miosis, lasting 5-10 seconds, with doubtful disconnection from the environment or consciousness impairment in some of the episodes, with no other accompanying signs or symptoms. Neurological examination between episodes was normal. He was evaluated by ophthalmology and otolaryngology, which ruled out pathology in these areas. Video-electroencephalogram showed electro-clinical correlations, with epileptiform activity in the left temporal and occipital region, which subsequently generalized during episodes. Brain MRI showed no pathological findings. After initiation of carbamazepine treatment, the patient had a good evolution, without recurrence of the episodes at 2 years of follow-up.


CONCLUSIONS
When faced with a case of acquired nystagmus, epileptic etiology should be included in the differential diagnosis, especially if the frequency of episodes is high, of short duration, and associated with consciousness impairment. The diagnosis is based on a video-electroencephalogram with electro-clinical correlations and a good response to treatment with antiepileptic drugs is expected.

/pdf/ictal-nystagmus-acquired-nystagmus-of-infrequent-cause-in-7ke3wsow.pdf

[Ictal nystagmus: acquired nystagmus of infrequent cause in pediatrics].

The aim of the study was to evaluate the prevalence, clinical characteristics, and diagnostic importance of nystagmus in children with brain tumours.A nation-wide retrospective review of all children diagnosed with a brain tumour between January the 1st, 2007 and December 31st, 2017, in Denmark. Data is based on information from the Danish Childhood Cancer Registry, hospital records from paediatric- and ophthalmological departments, and records from private ophthalmologists.Nystagmus was observed in 13.7% (60/437) of children with a brain tumour. In 50/60 children (83.3%) nystagmus was an incidental finding at the clinical examination and only in 10/60 children (16,7%) were nystagmus noticed by patient/caregivers prior to the clinical examination. In 38/60 children nystagmus was observed before the brain tumour diagnosis, most often (16/38, 42%) the same day as the diagnosis was made. In 22/60 children nystagmus was found after the brain tumour diagnosis (prior to any treatment) with a median of four days (range 0-47) after the brain tumour diagnosis. Nystagmus was most commonly binocular (56/60, 93.3%) and gaze-evoked (43/60, 71.7%). The median number of additional symptoms and/or clinical findings was five (range 0-11).Nystagmus is frequent in children with brain tumours and is typically accompanied by other symptoms and clinical signs. However, nystagmus is often first recognized by the ophthalmologist late in the time course. Therefore, raising awareness of the importance of looking for nystagmus in children with unspecific neurological symptoms might contribute to increased suspicion of brain tumour and thereby faster diagnosis. 

Nystagmus in children with primary brain tumours in Denmark between 2007 and 2017.

https://doi.org/10.1016/j.radcr.2022.06.001

Neuro-otology symptoms as the early sign in pediatric patient with a pineal gland tumor: a case report

Abstract Background The aim of the study was to evaluate the prevalence, clinical characteristics, and diagnostic importance of nystagmus in children with brain tumors. Methods A nation-wide retrospective review of all children diagnosed with a brain tumor between January the 1st, 2007 and December 31st, 2017, in Denmark. Data is based on information from the Danish Childhood Cancer Registry, hospital records from pediatric- and ophthalmological departments, and records from private ophthalmologists. Results Nystagmus was observed in 13.7% (60/437) of children with a brain tumor. In 50/60 children (83.3%) nystagmus was an incidental finding at the clinical examination and only in 10/60 children (16,7%) were nystagmus noticed by patient/caregivers prior to the clinical examination. In 38/60 children nystagmus was observed before the brain tumor diagnosis, most often (16/38, 42%) the same day as the diagnosis was made. In 22/60 children nystagmus was found after the brain tumor diagnosis (prior to any treatment) with a median of four days (range 0–47) after the brain tumor diagnosis. Nystagmus was most commonly binocular (56/60, 93.3%) and gaze-evoked (43/60, 71.7%). The median number of additional symptoms and/or clinical findings was five (range 0–11). Conclusion Nystagmus is frequent in children with brain tumors and is typically accompanied by other symptoms and clinical signs. However, it is often first recognized by the ophthalmologist late in the time course. Therefore, awareness of nystagmus and the importance to test for gaze-evoked forms might contribute to increased suspicion of brain tumor and thereby faster diagnosis. 

/pdf/nystagmus-in-children-with-primary-brain-tumors-in-denmark-1cnw37b0.pdf

Nystagmus in children with primary brain tumors in Denmark between 2007 and 2017

OBJECTIVES: Acute nystagmus (AN) is an uncommon neurologic sign in children presenting to pediatric emergency departments. We described the epidemiology, clinical features, and underlying causes of AN in a large cohort of children, aiming at identifying features associated with higher risk of severe underlying urgent conditions (UCs). METHODS: Clinical records of all patients aged 0 to 18 years presenting for AN to the pediatric emergency departments of 9 Italian hospitals in an 8-year period were retrospectively reviewed. Clinical and demographic features and the underlying causes were analyzed. A logistic regression model was applied to detect predictive variables associated with a higher risk of UCs. RESULTS: A total of 206 patients with AN were included (male-to-female ratio: 1.01; mean age: 8 years 11 months). The most frequently associated symptoms were headache (43.2%) and vertigo (42.2%). Ataxia (17.5%) and strabismus (13.1%) were the most common neurologic signs. Migraine (25.7%) and vestibular disorders (14.1%) were the most common causes of AN. Idiopathic infantile nystagmus was the most common cause in infants CONCLUSIONS: AN should be considered an alarming finding in children given the risk of severe UCs. Cranial nerve palsy, ataxia, and strabismus should be considered red flags during the assessment of a child with AN.

Characteristics of Acute Nystagmus in the Pediatric Emergency Department.

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Characteristics of Acute Nystagmus in the Pediatric Emergency Department.