Teaching Video NeuroImages: A Case of Lance Adams Syndrome With Seesaw Nystagmus

Abstract

Seesaw nystagmus (SSN) is a rare ocular manifestation characterized by cyclic movement of the eyes with a conjugate torsional component and a disjunctive vertical component. We present a 29-year-old woman with alcohol withdrawal seizure resulting in anoxic brain injury secondary to respiratory failure. On examination, she had multifocal myoclonus, dystonia, and SSN (video). The proposed mechanism is inactivation of the torsional eye-velocity integrator, the interstitial nucleus of Cajal, with sparing of the torsional fast-phase generator, the rostral interstitial nucleus of MLF. This is a unique case of Lance Adams syndrome 1,2 combined with SSN.