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Visual and Positional Modulation of Pendular Seesaw Nystagmus

Implications for the Mechanism

Kim, Sung-Hee MD, PhD; Kim, Hyo-Jung PhD; Oh, Sea-Won BSc; Kim, Ji-Soo MD, PhD

Journal of Neuro-Ophthalmology: June 2019 - Volume 39 - Issue 2 - p 181–185
doi: 10.1097/WNO.0000000000000678
Original Contribution

Background: The mechanisms of pendular seesaw nystagmus (SSN) remain unknown.

Methods: We evaluated modulation of pendular SSN by removal of visual fixation, convergence, and positional changes in 2 patients, one with bitemporal hemianopia due to a traumatic damage of the optic chiasm and the other with platybasia compressing the medulla and lower cerebellum.

Results: In both patients, the pendular SSN markedly decreased or disappeared with convergence, without visual fixation in darkness, during static head tilt toward each shoulder while sitting and while supine.

Conclusions: The similar patterns of nystagmus modulation observed in our patients with a different etiology indicate a common role of both visual and otolithic inputs in generating pendular SSN.

Department of Neurology (S-HK), Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea; Research Administration Team (H-JK), Seoul National University Bundang Hospital, Seongnam, South Korea; Dizziness Center (S-WO, J-SK), Seoul National University Bundang Hospital, Seongnam, Korea; and Department of Neurology (J-SK), Seoul National University College of Medicine, Seoul, Korea.

Address correspondence to Ji-Soo Kim, MD, PhD, Department of Neurology, College of Medicine, Seoul National University Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea; E-mail:

J.-S. Kim serves as an Associate Editor of Frontiers in Neuro-otology and on the Editorial Boards of the Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, Journal of Neurology, Medicine, and Journal of Vestibular Research. The remaining authors report no conflicts of interest.

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© 2019 by North American Neuro-Ophthalmology Society