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Images in Neurology
December 10, 2018

Seesaw-Pattern Ocular Bobbing in a Patient With Pontine Bleed

Author Affiliations
  • 1Neurosurgery, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
  • 2Neurology, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
JAMA Neurol. 2019;76(3):362-363. doi:10.1001/jamaneurol.2018.3853

A 35-year-old man was brought to the emergency department following sudden loss of consciousness, with a Glasgow Coma Scale score of 5 (eye opening, 2; verbal response, not testable; motor response, 3), pinpoint pupils, and left-sided hemiparesis (Medical Research Council grade of 2 of 5). His ocular examination revealed absent horizontal eye movements and a unique variant of typical ocular bobbing (Video). Magnetic resonance imaging of the brain with relevant sequences were highly suggestive of pontine hemorrhage secondary to cavernoma bleed (Figure 1 and Figure 2). The patient had 2 paroxysmal episodes of similar eye movements during his intensive care unit stay. The relatives later took the patient home against our medical advice after realizing his moribund medical status with dismal chance of recovery.

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