Periodic alternating skew deviation

James M. Mitchell, J. Lawton Smith, Robert M. Quencer

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)5-8
Number of pages4
JournalJournal of Clinical Neuro-Ophthalmology
Issue number1
StatePublished - Mar 1981

ASJC Scopus subject areas

  • Ophthalmology
  • Clinical Neurology


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