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Images in Neurology
September 2008

Inverse Ocular Bobbing in a Patient With Encephalitis Associated With Antibodies to the N-methyl-D-aspartate Receptor

Arch Neurol. 2008;65(9):1251. doi:10.1001/archneur.65.9.1251

A 30-year-old woman presented with headache, fever, disorientation, and recent memory disturbance. Brain magnetic resonance imaging showed fluid-attenuated inversion recovery hyperintense abnormalities in both hippocampi, without abnormal findings in other areas of the brain or brainstem.1 The patient subsequently developed tonic convulsions, restlessness, anxiety, and hypoventilation that led to the use of sedation and mechanical ventilation. While in the intensive care unit, inverse ocular bobbing and skew deviation were transiently observed (Figure) (a video is available here). Antibodies to NR1/NR2 heteromers of the N-methyl-D-aspartate receptor were identified in her serum and cerebrospinal fluid. After immunotherapy and removal of an ovarian teratoma, all symptoms started to improve and the patient was able to return to her job 1 year later.

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