Abstract
Saccades are rapid eye movements that shift gaze between successive fixation points. We report three patients who awoke from cardiopulmonary bypass with complete persistent loss of all fast eye movements, including voluntary and involuntary saccades and quick phases of nystagmus, with all other eye movements preserved. ### Case reports. #### Patient 1. A healthy 50-year-old woman underwent otherwise uncomplicated aortic valve replacement for an incidentally discovered ascending aortic aneurysm. Upon awakening from anesthesia, she noted difficulties directing her gaze and began using head movements to facilitate gaze shifts. She had no dysarthria, dysphagia, or gait instability. She was discharged and had no problems other than her visual symptoms for 3 months when she developed complex partial seizures that responded to levetiracetam. Ten months postoperatively, general neurologic examination was notable only for diffuse hyporeflexia. Visual acuity, pupils, visual fields, and funduscopic examination results were normal. Straight-ahead fixation was steady, and no spontaneous saccades, square wave jerks, or nystagmus was seen with ophthalmoscopy. She made no fast volitional or reflexive saccades in any direction, but instead made extremely slow eye movements to eventually reach a target, except for slightly faster downward …
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