Spasmus Nutans

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Abstract
To the Editor.— In the instructive article, "Spasmus Nutans: A Mistaken Identity" by Antony et al (Archives1980;37:373-375), three cases are presented in which a diagnosis of spasmus nutans was made when in fact each patient had tumors that involved the third ventricular region and optic chiasm. When the initial diagnosis of spasmus nutans was made, aside from the nystagmus, the results of the ocular examination were believed to be normal. However, there was no mention that a swinging flashlight test for a relative afferent pupil had been performed. This test may have a special pertinence whenever a diagnosis of spasmus nutans is made. In cases in which an asymmetric nystagmus is the result of a parachiasmal tumor, it is possible that the nystagmus is the result of a mass effect on the ocular motor system, or the nystagmus could be secondary to a predominately unilateral vision loss. A unilateral

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