Brain, Vol. 117, No. 4, 789-803, 1994
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Jerk-waveform see-saw nystagmus due to unilateral meso-diencephalic lesion
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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