Spasmus nutans presents within 4-12 months after birth and is often accompanied by compensatory head nodding.

• A. Latent nystagmus
• B. Gaze-evoked nystagmus
• C. Spasmus nutans
• D. Convergence-retraction syndrome

Answer: (C)

Infantile spasmus nutans is defined by onset in the first year of life, with a distinctive triad: nystagmus that can be pendular, and a compensatory head nodding to help stabilize gaze. This early onset (often within about 4–12 months) together with the head-nodding behavior is the hallmark that sets it apart. The condition is typically benign and tends to improve spontaneously over the next few years, usually resolving by early childhood.

Understanding why this fits better than the other patterns helps solidify the concept. Latent nystagmus occurs mainly when one eye is covered and isn’t characteristically accompanied by the head-nodding seen in spasmus nutans. Gaze-evoked nystagmus appears or worsens with sustained eccentric gaze and is more often linked to acquired or CNS-related issues, not the infantile onset pattern. Convergence-retraction syndrome involves problems with upgaze and dorsal midbrain pathways, producing a different set of eye movements and clinical signs not typical of infantile spasmus nutans.

So the combination of early infancy onset and compensatory head nodding with nystagmus points most clearly to spasmus nutans.