Periodic alternating skew deviation

J Clin Neuroophthalmol. 1981 Mar;1(1):5-8.


A 78-year-old hypertensive woman suddenly developed blurred vision, followed shortly by dizziness, difficulty walking with a tendency to veer to the left, and vertical diplopia. Examination 3 weeks later revealed a unique neuro-ophthalmologic motility pattern, which may be described as periodic alternating skew deviation. This previously unreported motility disturbance was associated with downbeat nystagmus in our patient, and a focal lesion at the level of the interstitial nucleus of Cajal was demonstrated on computed tomography. The spectrum of physiologically related motility patterns--including periodic alternating nystagmus, cyclic oculomotor paralysis, see-saw nystagmus, periodic alternating gaze deviation, "ping-pong" gaze, and intermittent aperiodic alternating skew deviation--has been considered and is helpful in topical neuro-ophthalmologic diagnosis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Brain Diseases / complications*
  • Brain Diseases / diagnosis
  • Brain Diseases / diagnostic imaging
  • Brain Stem
  • Diplopia / complications*
  • Dizziness / complications
  • Facial Paralysis / complications
  • Female
  • Humans
  • Movement Disorders / complications*
  • Nystagmus, Pathologic / complications*
  • Ophthalmoplegia / complications*
  • Tomography, X-Ray Computed