title: The role of MR imaging in investigating isolated pediatric nystagmus.
abstract: 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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors: Department of Ophthalmology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. vaishnavi.batmanabane@sickkids.ca.|Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada. vaishnavi.batmanabane@sickkids.ca.
authors: Vaishnavi
authors: V
authors: Batmanabane
authors: Department of Ophthalmology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
authors: Elise
authors: E
authors: Heon
authors: Department of Ophthalmology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
authors: Tianyang
authors: T
authors: Dai
authors: Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
authors: Prakash
authors: P
authors: Muthusami
authors: Department of Clinical Research Services, The Hospital for Sick Children, Toronto, ON, Canada.
authors: Shiyi
authors: S
authors: Chen
authors: Department of Ophthalmology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
authors: Arun
authors: A
authors: Reginald
authors: Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
authors: Shilpa
authors: S
authors: Radhakrishnan
authors: Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
authors: Manohar
authors: M
authors: Shroff
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005123:Eye / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009759:Nystagmus, Pathologic / Q000000981:diagnostic imaging*; D012189:Retrospective Studies
keywords: Brain; Central nervous system; Children; Magnetic resonance imaging; Nystagmus; Orbit; Visual electrophysiology