Ocular dipping in creutzfeldt-jakob disease.
BACKGROUND
Ocular dipping (OD), or inverse ocular bobbing, consists of slow, spontaneous downward eye movements with rapid return to the primary position. It has been mainly reported following hypoxic-ischemic encephalopathy, but has also been described in association with other types of diffuse or multifocal encephalopathies and structural brainstem damage.


METHODS
We report the case of a previously asymptomatic 66-year-old woman who presented with confusion, recent memory disturbances, and abnormal involuntary movements, followed by a coma. Abnormal spontaneous vertical eye movements consistent with OD developed from the fourth day after admission, and the patient died 20 days later. The pathological examination of the brain confirmed the diagnosis of Creutzfeldt-Jakob disease.


CONCLUSIONS
The precise location of damage causing OD is unknown. In contrast to ocular bobbing, OD has no localizing value itself, but structural brainstem damage is likely when it appears combined with other spontaneous vertical eye movements.
Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain. ; Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.
Fernando
F
Sierra-Hidalgo
Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain.
Sara
S
Llamas
Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain.
Juan Francisco
JF
Gonzalo
Department of Neurology, Hospital Universitario 12 de Octubre, Madrid, Spain.
Carmen
C
Sánchez Sánchez
Creutzfeldt-Jakob disease; coma; occular bobbing; ocular dipping