Table 1

Summary of patients with abnormal vertical optokinetic nystagmus

Sex Age U D L R MRI results/diagnosis
1M10y7mLu+++MRI, midline abnormality of the midbrain, periaqueductal grey matter, symmetrical abnormality of dorsal pons. Symmetry of the lesions favours a metabolic disorder
2F7y6mLuLu++MRI, bilateral occipital infarcts, right frontoparietal lesion. Haemorrhagic ischaemic infarct following mild birth asphyxia
3M7y9mLuLu++Niemann–Pick disease type C
4F14yLuLu++Niemann–Pick disease type C
5F8y5mLuLu++Gaucher disease type I. MRI, haemorrhagic lesion in the rostral midbrain of unknown aetiology
6F0y9mLuLuLuLuGaucher disease type II
7F5y5mLuLuLuLuGaucher disease type III
8F10y9mLu+LuLuGaucher disease type III
9F4y7mLu+LuLuGaucher disease type III
10F3y10mLu+LuLuGaucher disease type III
11F4y1m+LuLuLuGaucher disease type III
12M4y9m+LuLuLuMRI, dysmorphic basal ganglia, small corpus callosum, underdeveloped brainstem, particularly the pons
13F2y5mLuLuMRI, generalised decrease in bulk of the brain and delay in maturation of myelin
14F5y11m+++MRI, abnormality in right cerebellar white matter, right cerebellar peduncles and the right medulla. Appearances consistent with acute inflammatory or neoplastic lesion
15F2y+++MRI, dilatation of the whole ventricular system, as a result of hydrocephalus
16M3y+++MRI, lesion within the medial thalamic nuclei. Aetiology not known, possibly a metabolic disorder or post-viral encephalitic damage
17F8y9m+++MRI, bilateral symmetrical abnormality in upper part of the cerebral peduncles extending into the lower parts of the thalami on both sides. Leigh disease
18M2y2mLuMRI, discrete white matter lesions, lesions in basal ganglia and abnormality in the thalamus on both sides. Aetiology not known, possibly because of atypical infection
19M1y7mLu+MRI, incomplete cerebellar and dorsal pontine myelination, marked maturational delay
20M1y+LuMRI, cerebellar vermis hypoplasia, increased prominence of superior cerebellar peduncles. Joubert syndrome
21M2y6mMRI, absent cerebellar vermis, arachnoid cyst in the left posterior fossa. Joubert syndrome
22M6y2mMRI, multiple cerebral infarcts, due to antenatal thrombosis of aorta. Cortical blindness
23M5y5mMRI, white matter changes adjacent to posterior aspect of lateral ventricles, abnormality at cerebellar pontine angle. Appearances consistent with degeneration/demyelination
24M4y10mMRI, lesion in the brainstem near the IIIrd nerve nucleus. Focal ischaemia most likely aetiology
25M16y7mCerebral palsy. No MRI
26F1y7mUndiagnosed neurodevelopmental disorder. MRI, no abnormality
  • y = years, m = months, U = response to an upward moving optokinetic stimulus, D = response to a downward moving optokinetic stimulus, L = response to a leftward moving optokinetic stimulus, R = response to a rightward moving optokenetic stimulus, + = OKN present, − = OKN absent, Lu = lock up.

  • The first 13 patients listed are those with a vertical saccade initiation failure (in either direction, up/down, or both). The final 13 patients listed had absent VOKN (in either direction, up/down or both).

  • nb Lock up in response to an upward moving stimulus indicates a saccade initiation failure of down saccades. Lock up in response to a downward moving stimulus indicates a saccade initiation failure of up saccades.