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Ocular dipping in creutzfeldt-jakob disease.

Sierra-Hidalgo F, Llamas S, Gonzalo JF, Sánchez Sánchez C - J Clin Neurol (2014)

Bottom Line: Ocular dipping (OD), or inverse ocular bobbing, consists of slow, spontaneous downward eye movements with rapid return to the primary position.Abnormal spontaneous vertical eye movements consistent with OD developed from the fourth day after admission, and the patient died 20 days later.The pathological examination of the brain confirmed the diagnosis of Creutzfeldt-Jakob disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain. ; Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.

ABSTRACT

Background: Ocular dipping (OD), or inverse ocular bobbing, consists of slow, spontaneous downward eye movements with rapid return to the primary position. It has been mainly reported following hypoxic-ischemic encephalopathy, but has also been described in association with other types of diffuse or multifocal encephalopathies and structural brainstem damage.

Case report: We report the case of a previously asymptomatic 66-year-old woman who presented with confusion, recent memory disturbances, and abnormal involuntary movements, followed by a coma. Abnormal spontaneous vertical eye movements consistent with OD developed from the fourth day after admission, and the patient died 20 days later. The pathological examination of the brain confirmed the diagnosis of Creutzfeldt-Jakob disease.

Conclusions: The precise location of damage causing OD is unknown. In contrast to ocular bobbing, OD has no localizing value itself, but structural brainstem damage is likely when it appears combined with other spontaneous vertical eye movements.

No MeSH data available.


Related in: MedlinePlus

Schematic diagram showing the typical oculographic pattern of ocular dipping and its correlation with bedside observations of the eye movements.
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Figure 2: Schematic diagram showing the typical oculographic pattern of ocular dipping and its correlation with bedside observations of the eye movements.

Mentions: Ocular dipping is one of the spontaneous eye movements that may occur in unconscious patients.4 It is an intermittent and usually conjugate vertical eye movement consisting of a slow downward movement with a rapid return to the midpoint.5 The eyes do not elevate beyond the primary position (Fig. 2),6 and may remain in a resting downward position for several seconds before upward deviation.1 The complete cycle of movements comprising downward deviation and upward rapid recovery typically takes a few seconds. Horizontal eye movements in patients with OD usually cover the full range.6 The timing of the drift and return of the eyes to the primary position tends to vary, and the typical rhythmicity and small amplitudes of eye movements seen in nystagmus are lacking. Cycles may be continuous or intermittent; a cycle might start directly after the finish of the preceding cycle or after a short delay.7 The presence of a structural lesion involving the brainstem is very likely when other spontaneous vertical eye movements appear interspersed with OD (e.g., bobbing, reverse bobbing, or reverse dipping).5,8,9


Ocular dipping in creutzfeldt-jakob disease.

Sierra-Hidalgo F, Llamas S, Gonzalo JF, Sánchez Sánchez C - J Clin Neurol (2014)

Schematic diagram showing the typical oculographic pattern of ocular dipping and its correlation with bedside observations of the eye movements.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4017020&req=5

Figure 2: Schematic diagram showing the typical oculographic pattern of ocular dipping and its correlation with bedside observations of the eye movements.
Mentions: Ocular dipping is one of the spontaneous eye movements that may occur in unconscious patients.4 It is an intermittent and usually conjugate vertical eye movement consisting of a slow downward movement with a rapid return to the midpoint.5 The eyes do not elevate beyond the primary position (Fig. 2),6 and may remain in a resting downward position for several seconds before upward deviation.1 The complete cycle of movements comprising downward deviation and upward rapid recovery typically takes a few seconds. Horizontal eye movements in patients with OD usually cover the full range.6 The timing of the drift and return of the eyes to the primary position tends to vary, and the typical rhythmicity and small amplitudes of eye movements seen in nystagmus are lacking. Cycles may be continuous or intermittent; a cycle might start directly after the finish of the preceding cycle or after a short delay.7 The presence of a structural lesion involving the brainstem is very likely when other spontaneous vertical eye movements appear interspersed with OD (e.g., bobbing, reverse bobbing, or reverse dipping).5,8,9

Bottom Line: Ocular dipping (OD), or inverse ocular bobbing, consists of slow, spontaneous downward eye movements with rapid return to the primary position.Abnormal spontaneous vertical eye movements consistent with OD developed from the fourth day after admission, and the patient died 20 days later.The pathological examination of the brain confirmed the diagnosis of Creutzfeldt-Jakob disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain. ; Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.

ABSTRACT

Background: Ocular dipping (OD), or inverse ocular bobbing, consists of slow, spontaneous downward eye movements with rapid return to the primary position. It has been mainly reported following hypoxic-ischemic encephalopathy, but has also been described in association with other types of diffuse or multifocal encephalopathies and structural brainstem damage.

Case report: We report the case of a previously asymptomatic 66-year-old woman who presented with confusion, recent memory disturbances, and abnormal involuntary movements, followed by a coma. Abnormal spontaneous vertical eye movements consistent with OD developed from the fourth day after admission, and the patient died 20 days later. The pathological examination of the brain confirmed the diagnosis of Creutzfeldt-Jakob disease.

Conclusions: The precise location of damage causing OD is unknown. In contrast to ocular bobbing, OD has no localizing value itself, but structural brainstem damage is likely when it appears combined with other spontaneous vertical eye movements.

No MeSH data available.


Related in: MedlinePlus