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Title: Pendular seesaw nystagmus in a patient with a giant pituitary macroadenoma : pathophysiology and the role of the accessory optic system
Authors: Woo, PYM
Takemura, S
Cheong, AMY 
Chu, ACH
Chan, Y
Wong, HT
Chan, KY
Issue Date: Mar-2018
Source: Journal of neuro-ophthalmology, Mar. 2018, v. 38, no. 1, p. 65-69
Abstract: Seesaw nystagmus is characterized by cyclic eye movements with a conjugate torsional component and a dissociated vertical component. In the first half of the cycle, one eye elevates and intorts, whereas the other eye depresses and extorts. The pattern is reversed in the remaining half of the cycle. We describe a patient with a giant pituitary adenoma who developed pendular seesaw nystagmus. Disturbance in the visuovestibular system is postulated to contribute to this form of seesaw nystagmus. Lesions compressing the optic chiasm and the accessory optic system could interrupt the transmission of retinal error signals to the inferior olivary nucleus and the interstitial nucleus of Cajal, thus interfering with the adaptive mechanism of the vestibulo-ocular reflex and leading to pendular seesaw nystagmus.
Publisher: Lippincott Williams & Wilkins
Journal: Journal of neuro-ophthalmology 
ISSN: 1070-8022
EISSN: 1536-5166
DOI: 10.1097/WNO.0000000000000575
Rights: © 2017 by North American Neuro-Ophthalmology Society
This is the accepted version of an article published by Lippincott Williams & Wilkins in Journal of neuro-ophthalmology. To access the final edited and published work see
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