See-saw nystagmus, convergence-retraction nystagmus and contraversive ocular tilt reaction from a paramedian thalamomesencephalic infarct

Abstract

A 49-year-old healthy woman presented with sudden onset of binocular diplopia and unsteady gait. Physical examination showed convergence-retraction nystagmus on up-gaze and see-saw nystagmus on left-gaze (video 1). She also had ocular tilt reaction (OTR) with skew deviation, excyclotorsion of the left eye and left head tilt (video 1). Her extraocular eye movements and vestibulo-ocular reflex were normal. Her limb power was full but left lateropulsion was evident …