Seesaw nystagmus

Abstract

The authors report on a case of seesaw nystagmus in a 10 year old female patient with a cyst in the third ventricle with bitemporal hemianopsia obesity and occasional irregular side movements of the head. The nystagmus was the first sign of the disease and appeared 7 months before operative verification. It had a frequency of 150-160 cycles p/min. and an amplitude of the vertical and rotatory movements on the right side of aprox. 20°, on the left side of approx. 10°. Most expressive was the nystagmus in the primary position in distance gaze, in near gaze and in slight rotation of the head its intensity lowered and disappeared. In extreme eye positions in various visual directions namely in upward gaze the vertical component of the nystagmus diminished. Occasional side movements of the head were evaluated by neurosurgeons as bubble-head doll syndrome, pathognomic for the enlargement of the third ventricle by a cyst of stenosis of the aqueduct. The authors call attention to the fact that nodding head movements were seen by Maddox in the first description of seesaw nystagmus. Seesaw nystagmus and head nodding remain even one year after successful removal of the cyst. After analysis of 42 observations from the literature till 1977 the authors support the conception of a neurogenic origin of the affection.