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Horizontal nystagmus and multiple sclerosis using 3-Tesla magnetic resonance imaging

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Nystagmus in patients with multiple sclerosis (MS) is generally attributed to brainstem disease. Lesions in other regions may result in nystagmus. The identification of these other sites is enhanced by using 3-Tesla magnetic resonance imaging (3TMRI) due to increased signal-to-noise ratio.


We sought to evaluate the distribution of structural lesions and disruption of tracts in patients with horizontal nystagmus secondary to MS using 3TMRI.


Twenty-four patients (20 women, 4 men; age range 26–55 years) with horizontal nystagmus secondary to MS underwent 3TMRI brain scans; and 18 patients had diffusion tensor imaging (DTI) for tractography.


Nystagmus was bidirectional in 11, right-sided in 6 and left-sided in 7. We identified 194 lesions in 20 regions within the neural integrator circuit in 24 patients; 140 were within the cortex and 54 were within the brainstem. Only two patients had no lesions in the cortex, and 9 had no lesions in the brainstem. There was no relationship between side of lesion and direction of nystagmus. Thirteen of 18 (72 %) had tract disruption with fractional anisotropy (FA) values below 0.2. FA was significantly lower in bidirectional compared to unidirectional nystagmus (p = 0.006).


In MS patients with horizontal nystagmus, lesions in all cortical eye fields and their descending connections were evident. Technical improvements in tractography may help identify the specific site(s) resulting in nystagmus in MS.

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The authors wish to acknowledge funding by Health Research Board in Ireland to Centre for Advanced Medical Imaging for 3 Tesla MRI; Niall C. Colgan received financial support from Enterprise Ireland Postdoctoral Fellowship Grant #PC 2007/362 and Science Foundation Ireland # 09/RFP/CMS2408; Stephen D. Meredith was funded by Enterprise Ireland Grant #PC 2007/362; and Kathleen M. Curran received research support from Enterprise Ireland Grant #PC 2007/362, Science Foundation Ireland Grant # 09/RFP/CMS2408 and Irish Health Research Board grant # RP/2007/319.

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Correspondence to J. Redmond.

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Dr. Janice Redmond received an honorium from Merck Serono for attendance at an Advisory Board Meeting. Dr. Meredith reports grants from Enterprise Ireland, during the conduct of the study.

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Iyer, P.M., Fagan, A.J., Meaney, J.F. et al. Horizontal nystagmus and multiple sclerosis using 3-Tesla magnetic resonance imaging. Ir J Med Sci 185, 881–886 (2016).

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