Gaze-evoked eyelid and ocular nystagmus inhibited by the near reflex: unusual ocular motor phenomena in a lateral medullary syndrome.

Rhythmic movements of the upper eyelids are infrequent manifestations of brain-stem disease. Gowers (1879) noted the close coordination between movements of the upper lids and eyeballs in vertical nystagmus. He attributed this coordinated movement to the natural synkinesis of the levator palpebrae superioris and superior rectus muscles; this clinical observation was later verified electrophysiologically (Bj0rk and Kugelberg, 1953). Raudnitz (1897), in a paper on spasmus nutans, was perhaps the first to describe lid movements in association with horizontal ocular nystagmus. Pick (1916) employed the term 'lid nystagmus' (Nystagmus des Oberlides) to designate a phasic rhythmic jerking of the upper lid consisting of a fast upward flick and a slower downward drift. In his patient the lid nystagmus was evoked principally by convergence. Later that same year Popper (1916) reported a form of lid nystagmus in which a clinically obvious upward jerking of the lids occurred synchronously with the fast phase of a gaze-evoked horizontal ocular nystagmus. Subsequent reports of lid nystagmus have been rare. Sittig (1917), and Wilbrand and Saenger (1921) presented single cases of gaze-evoked lid and ocular nystagmus. Brain-stem dysfunction was evident in these cases, but discrete localization of the lesion could not be made pathologically or clinically. We have described in the accompanying report (Sanders, Hoyt, and Daroff, 1968) the electromyographic analysis in a case of convergence-evoked (Pick-type) lid nystagmus. The present report will: (1) describe clinical and electrodiagnostic findings from a typical example of the Popper-type of gazeevoked oculopalpebral nystagmus in a young woman with an otherwise paradigmatic lateral medullary