Differential Diagnosis for Vertical Nystagmus + Intoxication
Single Most Likely Diagnosis
- Wernicke's Encephalopathy: This condition is a common cause of vertical nystagmus in the context of intoxication, particularly alcohol. It is due to thiamine deficiency and can present with a triad of confusion, ophthalmoplegia, and ataxia, along with nystagmus.
Other Likely Diagnoses
- Alcohol Withdrawal: Severe alcohol withdrawal can lead to a range of neurological symptoms, including nystagmus. While horizontal nystagmus is more common, vertical nystagmus can occur, especially in more severe cases.
- Benzodiazepine or Other Sedative Intoxication: Intoxication with benzodiazepines or other sedatives can cause nystagmus, including vertical nystagmus, as part of their neurological effects.
- Vestibular Disorders: Conditions affecting the vestibular system, such as labyrinthitis or vestibular neuritis, can cause vertigo and nystagmus. While these are not directly related to intoxication, they could be considered in the differential if the patient's presentation is not clearly intoxication-related.
Do Not Miss Diagnoses
- Brainstem Stroke or Hemorrhage: A stroke or hemorrhage in the brainstem can cause vertical nystagmus due to the involvement of critical oculomotor pathways. This is a medical emergency that requires immediate attention.
- Traumatic Brain Injury: Significant head trauma can result in vertical nystagmus among other neurological deficits. The context of intoxication might increase the risk of trauma.
- Central Nervous System Infections: Infections like meningitis or encephalitis can present with a wide range of neurological symptoms, including nystagmus, and are critical to identify and treat promptly.
Rare Diagnoses
- Multiple Sclerosis: This demyelinating disease can cause a variety of neurological symptoms, including nystagmus, due to lesions in the central nervous system. Vertical nystagmus would be an uncommon initial presentation.
- Chiari Malformation: A structural defect in the cerebellum that controls balance can cause nystagmus among other symptoms. While not directly related to intoxication, it could be a rare underlying cause of vertical nystagmus.
- Medullary Thyroid Carcinoma: In rare cases, metastatic disease to the brainstem or cerebellum can cause nystagmus. This would be an uncommon diagnosis to consider in the context of intoxication and vertical nystagmus.