Abstract
Background: Acquired See-saw Nystagmus (SSN) is a rare form of nystagmus characterized by elevation and intorsion of one eye with synchronous depression and intorsion of the contralateral eye in the first half cycle, followed by a reversal in the direction of the movements during the next half cycle. We herein report a case of a 47-year-old woman with a 3-year history of constant diplopia as a consequence of multiple neurosurgical interventions due to hemorrhage from a cavernous angioma located in the subthalamic region. She also had a history of major depressive disorder and ulcerative colitis. The patient underwent a surgical intervention with a 5 mm bilateral recession of the superior and inferior rectus muscles. Five years after surgery, the patient reported less recurrent and prominent episodes of transient horizontal deviation with horizontal diplopia, with a prevalence of well-being and comfort.
Highlights
The earliest known description of see-saw nystagmus was in 1913 by Maddox [1]
Acquired See-saw Nystagmus (SSN) is a rare form of nystagmus characterized by elevation and intorsion of one eye with synchronous depression and intorsion of the contralateral eye in the first half cycle, followed by a reversal in the direction of the movements during the half cycle
We report a case of a 47-year-old woman with a 3-year history of constant diplopia as a consequence of multiple neurosurgical interventions due to hemorrhage from a cavernous angioma located in the subthalamic region
Summary
The earliest known description of see-saw nystagmus was in 1913 by Maddox [1]. In clinical practice, abnormal eye movements are frequently related to brain disorders. Known surgical treatments of different types of nystagmus include the Kestenbaum-Anderson method (a recession-resection procedure of the four rectus muscles), the Anderson technique (involving only recession of medial and lateral rectus muscles), or the application of both procedures in patients with a torsional component, as in the case of SSN: correction can be performed by weakening of the oblique muscle with the Kestenbaum principle, the Bietti principle (all four horizontal recti are recessed, with a 10 mm recession of the medial recti and a 12 mm recession of the lateral recti, avoiding consecutive exotropia and leading to a reduction in the frequency of the jerking movement by 50%), or with the most recent Dell’ Osso-Hertle procedure [7] (tenotomy of the horizontal muscles, thereby the simple detachment of the horizontal recti and reattachment at the original insertion would damp the proprioceptive feedback and the intensity of the jerk-like movements). The aim of this study is to evaluate the results obtained in a case of SSN treated using a new surgical technique of recession of the four vertical muscles
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