Cinema worker, two days after being waked up by a shell, develops a nystagmiform tremor of eyes and tachycardia. Graves’ disease? Tic (“occupational virtuosity”)?
Case 315. (Tinel, April, 1915.)
A soldier was waked up with a start Sept. 22, 1914, by a shell burst. The man was not wounded or shocked, and merely felt a good deal moved. The next day but one he felt a little movement of his eyes, which was at first intermittent but in three or four days became continuous and troublesome. These movements were those of nystagmus, almost transverse and very rapid, and suggestive rather of a vibratory trembling than of a true nystagmus of the eye or of labyrinthine disease. When the patient fixed an object, the nystagmus would stop for a few seconds and then immediately reappear. There had never been any vertigo, nausea, vomiting, deafness, ocular disorder, or disorder of equilibration. During the tests for nystagmus, the morbid nystagmus would stop and be replaced by the normal nystagmus which was obviously slower and more regular. The condition had persisted from September, 1914, to the meeting of the Neurological Society, April 15, 1915. The patient said he had become very emotional and got palpitations on the slightest occasion, such as a fast walk, going upstairs, or hearing a loud noise. There was also a slight vibratory trembling of the fingers and a permanent tachycardia (120-140 beats). Tinel regards the case as one of neurosis, due to a neuromuscular hyperexcitability comparable in some ways with that found in Graves’ disease.
Meige, in discussion, called attention to the fact that not every nystagmus is of organic origin and that there is a rare form of tic of nystagmiform nature. The victim in this case was an employee in a moving picture house, and very possibly his occupation had permitted him to utilize what Meige speaks of as a “occupational virtuosity” of the eye muscles.