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Brain, Vol. 117, No. 4, 789-803, 1994
© 1994 Guarantors of Brain

research-article

Jerk-waveform see-saw nystagmus due to unilateral meso-diencephalic lesion

G. M. Halmagy1,0, S. T. Aw1, I. Dehaene3, I. S. Curthoys2 and M. J. Todd1

1Department of Neurology, Royal Prince Alfred Hospital Sydney 2Department of Psychology, University of Sydney Sydney, Australia 3Department of Neurology, Algemeen Ziekenhuis Bruges, Belgium

Correspondence to: 0Correspondence to: Dr G. M. Halmagyi, Eye and Ear Research Unit, Neurology Department, RPA Hospital, Camperdown, NSW 2050, Sydney, Australia

See-saw nystagmus is an uncommon but highly characteristic eye movement disorder comprising intorsion and elevation of one eye, with synchronous extorsion and depression of the other. It generally has a pendular waveform and is due to a midline, extrinsic, suprasellar mass lesion compressing or invading the brainstem bilaterally at the meso-diencephalic junction. This report deals with the clinical and MRI findings in three patients (and binocular three-dimensional quantitative oculographic findings in one patient) with a jerk waveform see-saw nystagmus due in each case to a unilateral meso-diencephalic lesion. In each patient the torsional component of the nystagmus fast phases rotated the upper poles of the eyes toward the side of the lesion. Jerk see-saw nystagmus can be clinically indistinguishable from pendular see-saw nystagmus and from the torsional-vertical nystagmus which occurs with medullary lesions. We propose that jerk see-saw nystagmus is due to unilateral inactivation of the torsional eye-velocity integrator, thought to be in the interstitial nucleus ofCajal, with sparing of the torsional fast-phase generator, thought to be in the adjacent rostral interstitial nucleus of the medial longitudinal fasciculus.

see-saw nystagmus; torsional nystagmus; interstitial nucleus of Cajal; rostral interstitial nucleus of the medial longitudinal fasciculus

Received August 3, 1993. Revised January 24, 1994. Accepted February 22, 1994.


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