Most of us have been there before. A puking, nearly unconscious teenager on our pram. All the 
predictable problems; airway issues, responsiveness issues, behavioral issues. When kids learn the hard lessons about alcohol and drugs we’re often the ones who get called in to clean up the mess. And, as tiring as the routine gets, we do what we can.
We protect the airway, administer our oxygen, start the IV, monitor the capnography, pay attention to the heart rhythms, the whole kit-n-kaboodle. (You may use another term … that’s just me.) The subtleties of treatment change with level of certification and protocols, but the call runs remarkably the same.
Some medics is Tulsa, OK decided that we run this call far to often and they got the bright idea to see if they could change that dynamic. Today in high school classrooms around Tulsa EMT’s and Paramedics are taking their kits and prams into the classrooms to talk to teenagers about just what it’s really like to be laying on that pram after an alcohol or drug use mishap.
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When we think of testing for nystagmus, medical personnel and lay people alike, we tend to think 
of the horizontal gaze nystagmus test performed by police officers as part of the standard field sobriety test (SFST). It’s true that the police have taken this useful neurological exam and put it to good use to identify folks who may have had to much to drink. There are other good uses for the nystagmus test as well.
I use the horizontal gaze nystagmus test as a part of the basic neurological exam that I do any time I’m uncertain of how well a patients brain is talking with their body. Head injuries, altered mentation, syncope, dizziness and headaches are some of the common complaints that make me want to check out how well the patients brain is doing its job. So this test gets pulled out of the tool box frequently. But what is nystagmus anyway? How do you really test for it and what does it tell you when you find it?
What is nystagmus?
Imagine that I took a large drum and I painted it white with black stripes running evenly down it. Then I set the drum on an axis and spun it slowly in one direction. As you watched the drum your eyes would focus on a black stripe and follow it across the surface of the drum until the stripe moved out of visual range. Then your eyes would jump backward to acquire a new stripe and follow it. This repetitive cycle of smooth eye pursuit interrupted by fast twitches (saccadic movement) is what we call nystagmus.
This peculiar tracking of the eye can be induced by spinning in a chair, riding on a roller coaster or observing a spinning object like in the example above (AKA Opticokinetic nystagmus). It can also be caused by a wide variety of medical and pharmocological conditions. Most causes of nystagmus point to an abnormal condition within the nervous system. It is a physical finding that calls us to pay attention and look deeper.
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