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April 1986

Ocular Bobbing in Association With Other Signs of Midbrain Dysfunction

Author Affiliations

Uniformed Services University of the Health Sciences Bethesda, MD 20814-4799
Walter Reed Army Medical Center Washington, DC 20307-5001

Arch Neurol. 1986;43(4):314. doi:10.1001/archneur.1986.00520040004003

To the Editor.  —We read with interest about the patients, as described by Keane,1 with repetitive, spontaneous downward and inward movements followed by a slower than normal return to the primary position. Keane suggested that these patients did not have true ocular bobbing and he termed the movements "pretectal pseudobobbing." We would like to suggest that these patients did in fact have true (albeit atypical) ocular bobbing2 in association with other signs of midbrain dysfunction, specifically convergence spasm. This possibility is suggested by a similar patient with increased intracranial pressure who manifested a spontaneous ocular movement similar to that in Keane's patient with intermittent downward and inward jerks followed by a slower than normal return to the primary position, as well as true typical ocular bobbing without a convergent movement and intermittent convergence spasms without any downward component.

Report of a Case.  —A 60-year-old man was well until