![]() ![]() It has been called “pupillary hippus” (PH), “pupillary athetosis”, or, in English-speaking countries, “pupillary unrest” or “dancing pupils”, terms that seem, however, to be rather non-specific. It is a very characteristic behavior of the pupil, which dilates and contracts cyclically in the presence of constant lighting, independently of eye movements or change in illumination. In this paper, a sign that has been well known for years and whose origin has never been defined with certainty, so much so that it was classically considered a phenomenon without clinical value, was taken into consideration. Having an instrumental hallmark would be extremely useful, especially in cases where the clinical picture does not fully meet the international diagnostic criteria. This implies that it is necessary to spend time collecting the detailed clinical history of the patient who, however, is not always able to describe his symptoms exactly with the risk of omitting important details for diagnostic purposes. The instrumental examination of patients with VM shows normal results or variable and inconsistent abnormalities, but vestibular testing needs to be performed with the aim of excluding other disorders considered in differential diagnosis. While the presence or history of migraine is essential for its diagnosis, the headache and dizzy symptoms do not need to temporally coincide. The diagnosis is primarily based on clinical history, and international guidelines have been developed. VM is now considered as the first cause of episodic vertigo in adults, and it is a common diagnosis in children. Vestibular migraine (VM) is characterized by recurrent vestibular attacks that are not associated with migraine headache. (4) Conclusion: we propose the consideration of the presence of pupillary nystagmus as an objective sign (present in the inter-critical phase) to be associated with the international diagnostic criteria for the diagnosis of vestibular migraine. This resulted in a test sensitivity of 0.93% and a specificity of 0.94%. ![]() Among the 50 non-migraineurs dizzy patients, three had pupillary nystagmus, while the remaining 47 did not. (3) Results: Among the 30 VM patients, only two cases were found to be negative for pupillary nystagmus. (2) Methods: 30 patients with dizziness suffering from vestibular migraine (VM), diagnosed according to the international criteria, were evaluated for the presence of pupillary nystagmus and compared with the results obtained in a group of 50 patients complaining of dizziness that was not migraine-related. The aim of this study is to verify the presence of pupillary nystagmus in a series of patients suffering from vestibular migraine. (1) Background: Hippus (which in this paper will be called “Pupillary nystagmus”) is a well-known phenomenon which has never been related to any specific pathology, so much so that it can be considered physiological even in the normal subject, and is characterized by cycles of dilation and narrowing of the pupil under constant lighting conditions. This rare phe- nomenon is spasmodic, cyclic and bilaterally in phase, and is usually considered benign. Pupillary hippus (PH) refers to spontaneous bilateral synchronous rhythmic constriction and dilatation of the pupils. If the right side of the neck is subjected to a painful stimulus, the right pupil dilates (increases in size 1-2mm from baseline). The ciliospinal reflex (pupillary-skin reflex) consists of dilation of the ipsilateral pupil in response to pain applied to the neck, face, and upper trunk. What causes pupillary hippus? What happens in the Ciliospinal reflex? It has been hypothesized that it reflects a dysregulation of central parasympathetic nervous system activity. Pupillary athetosis-or hippus-is bilateral, rhythmic oscillations of the pupil regardless of light intensity. What causes abnormal pupillary reflex?Ībnormal pupillary light reflex can be found in optic nerve injury, oculomotor nerve damage, brain stem lesions, such as tumors, and medications like barbiturates. Sometimes your pupils can dilate without any change in the light. When it’s bright, they get smaller, or constrict, to let in less light. ![]() In low light, your pupils open up, or dilate, to let in more light. Your pupils get bigger or smaller, depending on the amount of light around you.
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