Ocular bobbing: the myth of its localizing value

The clinical spectrum of ocular bobbing and ocular dipping

The term "ocular bobbing" defines a distinctive class of abnormal spontaneous vertical eye movements which occur in a variety of clinicopathological settings. Four cardinal forms, which correspond to the predicted permutations of the two characteristic clinical variables, initial vertical excursion and phasic velocity, have now been described. Reverse ocular dipping, with directional reversal and phasic inversion from typical ocular bobbing, is the last link in this functional tetrad and is newly presented. The four pathological forms share several basic phenomenological features but exhibit clinical and aetiological diversity and significant differences in prognosis. An analysis of the clinical spectrum of disorders subsumed under the general heading of "ocular bobbing" is presented.

Locked-in syndrome associated with ocular bobbing

Locked-in syndrome together with an ocular bobbing phenomenon was observed in a 41-year-old man, an association which has not been reported earlier. Computerized tomography demonstrated an infarction of the medio-ventral portion of the pons. The patient survived and is still alive ten months after the onset of the disease with severe neurological deficit.

Clinicopathological study of pontine hemorrhage

This report concerns a clinico-pathological study of 60 patients afflicted with primary pontine hemorrhage. The illness was fatal in 43, 17 patients survived. Ophthalmic signs, autonomic disturbances and transient visual hallucination were observed and discussed. A ruptured microaneurysm within the border of a pontine hematoma was detected in this study, and in the first report of such a finding.

Ocular bobbing in encephalitis

Abnormal eye movements described as ocular bobbing are most often encountered in the setting of pontine vascular disease. This report deals wih the onset and course of ocular bobbing in a young woman who had encephalitis confirmed by biopsy. Unusual eye movements developed during progressive deterioration of brain and brain stem function which led to coma. The eye movements occurred spontaneously and could also be triggered by cutaneous stimulation of the face, head, extremities, and auditory canals. The patient recovered fully over a period of several months.

Recovery from primary pontine hemorrhage

A patient with primary pontine hemorrhage showed typical ocular bobbing with only mild alteration of mental status. Serial CT scans showed resolution of the hemorrhage and correlated with clinical improvement.

Ocular bobbing with superior cerebellar artery aneurysm. Case report

A teen-age girl became comatose after the sudden onset of headache. Initial angiography did not reveal the site of bleeding. The subsequent onset of ocular bobbing directed attention to the region of the pons. Repeated angiography showed an aneurysm of the superior cerebellar artery. At surgery, the fundus of the aneurysm was adherent to the pons and there was a small hematoma within the pons. Ocular bobbing is rare, but is most commonly seen in association with destructive lesions of the pontine tegmentum, and is a useful localizing sign.

Ocular bobbing with extra-axial haematoma of posterior fossa

A patient with a subarachnoid haematoma anterior to the brain stem demonstrated "typical" ocular bobbing. The absence of CNS parenchymal involvement is distinct from previously described posterior fossa lesions associated with this particular eye movement disorder.