Spasmus nutans is a disorder affecting infants and young children. It involves rapid, uncontrolled eye movements, head bobbing, and sometimes, holding the neck in an abnormal position.
Causes
Most cases of spasmus nutans begin between age 6 months and 1 year. It usually lasts about 2 years but can go on as long as 5 years.
The cause is unknown, although it may be associated with other medical conditions. A link with iron or vitamin D deficiency has been suggested. In very rare cases, symptoms similar to spasmus nutans may be due to certain types of brain tumors or other serious conditions.
Symptoms
Symptoms of spasmus nutans include:
- Small, quick, side-to-side eye movements called nystagmus (both eyes are involved, but each eye may move differently)
- Head nodding
- Head tilting
Exams and Tests
Your health care provider will perform a physical exam of your child. You may be asked about your child’s symptoms.
Tests may include:
- CT scan of the head
- MRI scan of the head
- Electroretinography, a test that measures the electrical response of the retina (the back part of the eye)
Treatment
Spasmus nutans that isn’t related to another medical problem, such as brain tumor, requires no treatment. If the symptoms are caused by another condition, your provider will recommend appropriate treatment.
Outlook (Prognosis)
Usually, this disorder goes away on its own without treatment.
When to Contact a Medical Professional
Call for an appointment with your child’s provider if your child has rapid, movements of the eyes, or head nodding. The provider will need to perform an exam to rule out other possible causes for the symptoms.
References
American Academy of Ophthalmology website. Spasmus nutans. eyewiki.aao.org/Spasmus_Nutans. Updated July 24, 2022. Accessed May 23, 2023.
Hertle RW, Hanna NN. Supranuclear eye movement disorders, acquired and neurologic nystagmus. In: Lyons CJ, Lambert SR, eds. Taylor and Hoyt’s Pediatric Ophthalmology and Strabismus. 6th ed. Philadelphia, PA: Elsevier; 2023:chap 91.
Rucker JC, Lavin PJM. Neuro-ophthalmology: ocular motor system. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley’s and Daroff’s Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 18.
Review Date 4/29/2023
Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Shaken baby syndrome is a severe form of head injury caused by the baby’s brain rebounding inside of the baby’s skull when shaken. In this injury there is bruising of the brain, swelling, pressure, and bleeding (intracerebral hemorrhage). This can easily lead to permanent, severe brain damage or death. If a child has this injury there are usually no outward physical signs of trauma, but there may be a change in the child’s behavior such as irritability, lethargy, pale or bluish skin, vomiting, and convulsions.
Considerations
Shaken baby syndrome can occur from as little as 5 seconds of shaking. Shaken baby injuries most often occur in children younger than 2 years old, but may be seen in children up to 5 years old. When an infant or toddler is shaken, the brain bounces back and forth against the skull. This can cause bruising of the brain (cerebral contusion), swelling, pressure, and bleeding in the brain. The large veins along the outside of the brain may tear, leading to further bleeding, swelling, and increased pressure. This can easily cause permanent brain damage or death. Shaking an infant or small child may cause other injuries, such as damage to the neck, spine, and eyes.
Causes
Most cases are due to an angry parent or caregiver shaking the baby to punish or quiet it. Such shaking most often takes place when the infant is crying inconsolably and the frustrated caregiver loses control. Many times the caregiver did not intend to harm the baby. Still, it is a form of child abuse. Injuries are most likely to happen when the baby is shaken and then the baby’s head hits something. Even hitting a soft object, such as a mattress or pillow, may be enough to injure newborns and small infants. Children’s brains are softer, their neck muscles and ligaments are weak, and their heads are large and heavy in proportion to their bodies. The result is a type of whiplash, similar to what occurs in some auto accidents. Shaken baby syndrome does not result from gentle bouncing, playful swinging or tossing the child in the air, or jogging with the child. It also is very unlikely to occur from accidents such as falling off chairs or down stairs, or accidentally being dropped from a caregiver’s arms. Short falls may cause other types of head injuries, although these are often minor.
Symptoms
- Convulsions (seizures)
- Decreased alertness
- Extreme irritability or other changes in behavior
- Lethargy, sleepiness, not smiling
- Loss of consciousness
- Loss of vision
- No breathing
- Pale or bluish skin
- Poor feeding, lack of appetite
- Vomiting
There may not be any physical signs of injury, such as bruising, bleeding, or swelling. In some cases, the condition can be difficult to diagnose and may not be found during an office visit. However, rib fractures are common and can be seen on x-rays.
An eye doctor may find bleeding behind the baby’s eye or retinal detachment. There are, however, other causes of bleeding behind the eye and they should be ruled out before diagnosing shaken baby syndrome. Other factors must be considered.
First Aid
Call 911 or your local emergency number. Immediate emergency treatment is necessary.
If the child stops breathing before emergency help arrives, begin CPR.
If the child is vomiting:
- And you do not think there is a spinal injury, turn the child’s head to one side to prevent the baby from choking and breathing in vomit to the lungs (aspiration).
- And you do think there is a spinal injury, carefully roll the child’s whole body to one side at the same time (as if rolling a log) while protecting the neck to prevent choking and aspiration.
