Slowly alternating skew deviation: description of a pretectal syndrome in three patients

Ann Neurol. 1981 Dec;10(6):540-6. doi: 10.1002/ana.410100608.


Three patients who had slowly alternating skew deviation are described; each had elements of the Sylvian aqueduct syndrome. This combination of signs supports a pretectal location for lesions associated with alternating skew movements. Postmortem examination of a patient who died of chronic herpes simplex encephalitis showed extensive demyelination and periaqueductal spongiform degeneration; there was preservation of the oculomotor and trochlear nuclei, the medial longitudinal fasciculus, vestibular nuclei, and the interstitial nucleus of Cajal bilaterally. The slowly alternating dysconjugate vertical movements bear a resemblance to both see-saw nystagmus and the ocular tilt response.

Publication types

  • Case Reports

MeSH terms

  • Brain / pathology
  • Cerebral Aqueduct / pathology*
  • Cerebral Infarction / pathology*
  • Demyelinating Diseases / pathology
  • Encephalitis / pathology*
  • Eye Movements*
  • Female
  • Herpes Simplex / pathology*
  • Humans
  • Middle Aged
  • Nerve Degeneration
  • Nystagmus, Pathologic / pathology
  • Saccades
  • Superior Colliculi / pathology*