Teaching Video NeuroImages: Slow upward ocular bobbing

Slow upward ocular bobbing consists of slow upward conjugate eye movement, followed by a fast downward return to midposition, previously described with pontine pathology.^1,2 Our patient had an undiagnosed CSF leak in the setting of a postoperative pseudomeningocele with decline in her level of consciousness, absent oculocephalic reflexes, and intact corneal and pupillary light reflexes. She exhibited slow upward ocular bobbing (video on the Neurology® Web site at Neurology.org), which increased in frequency with noxious stimuli. Imaging revealed brain sag with ventral pontine flattening. Despite repair of the pseudomeningocele, the patient remained comatose requiring mechanical ventilation and passed shortly after care was withdrawn.

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