Hemi-see-saw nystagmus with superimposed pendular oculopalatal tremor: case report and systematic review.
Jesus Gutierrez-Arratia, Fiorella Rivas-Sarmiento, Christoper A Alarcon-Ruiz et al.
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Case in brief
A 30-year-old man with a pontomedullary arteriovenous malformation presented with pendular hemi-see-saw nystagmus, right one-and-a-half syndrome, gaze-evoked nystagmus, ocular tilt reaction, incomplete Horner syndrome, and oculopalatal tremor. The report places this presentation in a systematic review of 57 cases of hemi-see-saw or closely related dissociated vertical-torsional nystagmus. Across the reviewed cases, jerk nystagmus predominated; pendular nystagmus occurred in the setting of oculopalatal tremor or inferior olivary hypertrophy. Improvement was generally not reported in oculopalatal-tremor-related cases, with one exception of spontaneous resolution after 20 years.
What made this case unusual
The index case combined pendular hemi-see-saw nystagmus with oculopalatal tremor and multiple brainstem signs in the setting of a pontomedullary arteriovenous malformation, contrasting with the more typical jerk waveform.
Diagnostic / clinical pearl
Hemi-see-saw nystagmus is usually jerk-pattern; a pendular waveform should prompt consideration of associated oculopalatal tremor or inferior olivary hypertrophy.