The role of MR imaging in investigating isolated pediatric nystagmus

• Published in: Pediatric radiology 2016-11, Vol.46 (12), p.1721-1727
• Main Authors: Batmanabane, Vaishnavi, Heon, Elise, Dai, Tianyang, Muthusami, Prakash, Chen, Shiyi, Reginald, Arun, Radhakrishnan, Shilpa, Shroff, Manohar
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Eye - diagnostic imaging; Female; Humans; Imaging; Infant; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Neuroradiology; Nuclear Medicine; Nystagmus, Pathologic - diagnostic imaging; Oncology; Original Article; Pediatrics; Radiology; Retrospective Studies; Ultrasound
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-016-3669-9

Background The use of MRI in isolated pediatric nystagmus remains a gray area in clinical management. Many clinicians prefer to order an MRI to rule out intracranial pathology despite the lack of clinically significant findings in most cases. Objective To assess the yield of MR imaging in isolated pediatric nystagmus and define a management algorithm to minimize avoidable MRI referrals and streamline MRI protocols. Materials and methods We reviewed the charts of 148 children who underwent neuro MRI for isolated nystagmus between January 2008 and September 2014. We noted nystagmus onset and clinical characteristics and compared them with the MRI features and visual electrophysiology results. Results We included 85 boys and 63 girls (total 148, average age at MRI 4.24 ± 4.19 years). Twenty-three (15.5%) children had abnormal intracranial findings on MRI including abnormal signal lesions (4.1%; n =6), Chiari I malformations (3.4%; n =5) and optic pathway glioma (2.0%; n =3). The time of onset of nystagmus was not associated with an abnormal MRI ( P =0.2). Seventy children underwent visual electrophysiology testing but this test could not predict abnormality at MRI, either ( P =0.12). Conclusion Among children with isolated nystagmus, 15.5% had abnormalities on neuroimaging. Neither clinical characteristics of nystagmus nor the visual electrophysiology results allowed prediction of intracranial pathology. We were unable to formulate a management algorithm for the optimal sequence of investigations (MRI preceding visual electrophysiology or vice versa), but we discuss the use of gadolinium contrast agent and orbital sequences in isolated pediatric nystagmus.