Inverse ocular bobbing

Abstract

A new form of abnormal spontaneous eye movement termed inverse ocular bobbing is described. It consists of a slow downward eye movement followed by delayed quick return upward to midposition. It is contrasted with other types of abnormal vertical eye movements.

Postictal Ocular Dipping in a Patient With Traumatic Brain Injury

“…The patient became comatose after the seizures and showed spontaneous vertical up-and-down eye movements. This movement was consistent with ocular dipping, first described by Ropper in 1981, characterized by conjugate, slow downgaze and a quick return to primary position, which was also named inverse ocular bobbing (1,2). Besides the typical ocular dipping, a variant was also observed in our patient, in which there was an interval of sustained downward deviation before the return upward movement and the eyes could not reach the midposition.…”

“…The ocular dipping in our patient developed after a series of seizure attacks. Actually, 2 similar cases of ocular dipping during the phase of recovery from status epilepticus were reported by Knobler in 1981 (2). It is possible that cerebral anoxic ischemic injury during the prolonged status epilepticus resulted in postictal functional suppression of the cortex, facilitating the occurrence of ocular dipping.…”

Ocular Dipping in Creutzfeldt-Jakob Disease

“…It occurs most often in hypoxic or metabolic encephalopathy (9)(10)(11)(12)(13). In contrast to ocular bobbing, which consists of a rapid downward movement of the eyes followed by slow return to the primary position and is generally regarded a sign of intrinsic pontine lesions (14,15), ocular dipping does not have localizing value and usually indicates diffuse brain dysfunction (8)(9)(10).…”

Saccadic Intrusions and Oscillations

“…These saccadic intrusions are less often detected than rhythmic ocular bobbing (see below) but they have the same significance. The instrusive saccade is usually downward (Susac et al, 1970) but upward bobbing also occurs (Knobler et al, 1981).…”