Torsional Nystagmus in Syringobulbia: An association often listed, but rarely described

Syringobulbia is characterized by a syrinx in the brainstem, typically the medulla. Torsional nystagmus is a common sign in syringobulbia. It tops the list of causes of torsional nystagmus in two works on Neuro-ophthalmology, yet the association receives little attention. It is characterized by rhythmical slow followed by fast corrective movements about the visual axis. Initially it may be present in extreme lateral gaze, but over time it may present in all directions. Primarily torsional nystagmus is usually due to diseases affecting the central vestibular connections such as brainstem stroke, tumor, vascular malformations, multiple sclerosis and trauma. We report a patient whose oscillopsia from torsional nystagmus led to discovery of syringobulbia.