Myasthenic (Vertical) Nystagmus

Abstract
An unusual delayed-onset myasthenic nystagmus appearing during sustained upward gaze suggested the presence of brain-stem disease in a 35-year-old construction worker who was being evaluated for his complaints of progressive instability of gait. The etiology of the nystagmus and the systemic symptoms was established objectively by an edrophonium chloride (Tensilon) tonogram test; this is a sensitive means of recording edrophonium-induced increase in extraocular muscle tone as indicated by a rise in the Schiotz tonogram.

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