To the Editor.—
With regard to the article "Ocular Dipping in Anoxic Coma" (Archives 1981;38:297-299) by Allan H. Ropper, MD, I observed such ocular vertical movements (dipping or atypical bobbing1) in a girl with clinical signs of Wernicke's encephalopathy.2 The patient was alert and without trouble in lateral gaze, but had upward gaze palsy and vertical nystagmus, which showed that all ocular symptoms could probably be caused by a limited lesion in the pretectal area.The full mental alertness with intact cortical functions and the absence of extrapyramidal troubles in my patient show that cortical or basal ganglia damage is not necessarily present in cases of ocular dipping. The selective vulnerability of few neuronal systems, as occurred in this case of Wernicke's encephalopathy, is a better aid to identification of the lesional topography of ocular dipping than is the global disturbance observed in cases of anoxic encephalopathy.
Luda E. Ocular Dipping. Arch Neurol. 1982;39(1):67. doi:10.1001/archneur.1982.00510130069024
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