Allen Claire, Duarte Siena, Hwang Jaeho, Geocadin Romergryko G, Green Kemar E
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Neurology, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA.
Neurohospitalist. 2025 Apr 29:19418744251331649. doi: 10.1177/19418744251331649.
Spontaneous vertical eye movements in the critical care setting are often a source of confusion and alarm; while their origin remains at least partly theoretical, understanding their classification and associated clinical implications can inform the diagnostic workup and further clinical management. This case describes a patient who demonstrated ocular dipping: slow conjugate downward eye movements with a quick return to primary gaze. Ocular dipping is a rare phenomenon that was initially described in patients with hypoxic brain injury and has since been described in only a handful of cases. Dipping resides in a spectrum of spontaneous vertical eye movements, with ocular bobbing being the first of these described eye movements. Ocular bobbing is characterized by a fast downward movement followed by a slow return to the mid gaze position which is classically associated with pontine injury. Other vertical eye movements that can be seen in patients with a disorder of consciousness include other variations of ocular bobbing and dipping, vertical myoclonus, and small-amplitude mainly vertical movements.
在重症监护环境中，自发性垂直眼球运动常常是困惑和警报的来源；虽然其起源至少部分仍属理论范畴，但了解它们的分类及相关临床意义可为诊断检查和进一步的临床管理提供依据。本病例描述了一名表现出眼球下跳的患者：眼球缓慢共轭向下运动并快速回到初始注视位置。眼球下跳是一种罕见现象，最初在缺氧性脑损伤患者中被描述，此后仅在少数病例中被报道。下跳属于自发性垂直眼球运动范畴，眼球摆动是最早被描述的此类眼球运动。眼球摆动的特征是快速向下运动，随后缓慢回到中间注视位置，这经典地与脑桥损伤相关。意识障碍患者中可见的其他垂直眼球运动包括眼球摆动和下跳的其他变体、垂直性肌阵挛以及主要为垂直方向的小幅度运动。
