Saccadic Hypermetria and Ipsipulsion (Behind Closed Eyelids and with Vertical Saccades)

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Identifier Saccadic_dysmetria_ipspulsion
Title Saccadic Hypermetria and Ipsipulsion (Behind Closed Eyelids and with Vertical Saccades)
Subject Jerk Nystagmus; Torsional Nystagmus; Saccades; Lateropulsion; Medulla
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine
Description This is a 40-year-old woman who experienced oscillopsia and vertical diplopia, due to spontaneous torsional nystagmus and a skew deviation (right hypotropia), respectively. The symptom onset was 7 months prior to these videos. MRI demonstrated ill-defined T2 and FLAIR hyperintensity signal changes involving subcortical white matter and throughout the midbrain and ventral medulla suggestive of a demyelinating, vasculitic or inflammatory condition. Although there was no discrete right sided lateral medullary lesion, she had 1) hypermetric saccades to the right, 2) a rightward trajectory with vertical saccades, and 3) rightward ocular lateropulsion (i.e., eyes drift to the right with eyelid closure, also apparent on her MRI), as well as the torsional nystagmus. These are features that are commonly seen with a (right) lateral medullary syndrome (in addition to her right hypotropia), as the climbing fibers connecting (left) inferior olive to (right) dorsal vermis are injured. See diagram of the normal pathways (, and what happens with a lateral medullary lesion ( Further work-up (including cerebrospinal fluid analysis) is ongoing, although HIV, SS-A/B, ACE, ANCA, GAD-65, SPEP, NMO, ANA, RPR, and Lyme were negative or normal. For an example of characteristic neurologic and ocular motor findings in a lateral medullary (Wallenberg) syndrome, see
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2018
Type Image/MovingImage
Format video/mp4
Relation is Part of NOVEL: Neuro-ophthalmology Virtual Education Library Examination Collection
Rights Management Copyright 2018. For further information regarding the rights to this collection, please visit:
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Language eng
ARK ark:/87278/s64r24wd
Setname ehsl_novel_gold
Date Created 2018-11-26
Date Modified 2021-06-28
ID 1383127
Reference URL
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