Neuro-ophthalmology and pupils: see-saw nystagmus: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Neuro-ophthalmology and pupils: see-saw nystagmus

Sample item

A man with bitemporal hemianopia from a large suprasellar tumour also has an oscillation in which one eye rises and intorts while the other falls and extorts, alternating cyclically. What is this?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. See-saw nystagmus

See-saw nystagmus is a rare disjunctive oscillation associated with parasellar lesions that affect the diencephalon and chiasmal region. It may accompany a bitemporal field loss. Downbeat nystagmus points to a craniocervical junction problem instead.

Option by option

  • A. Congenital pendular nystagmus

    Congenital pendular nystagmus is horizontal and present from infancy.

  • B. Convergence-retraction nystagmus

    Convergence-retraction nystagmus occurs with attempted upgaze in dorsal midbrain lesions.

  • C. See-saw nystagmus (correct)

    Correct. Alternating rise and intorsion with fall and extorsion is see-saw nystagmus of parasellar lesions.

  • D. Downbeat nystagmus

    Downbeat nystagmus has a downward fast phase and suggests the craniocervical junction.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is C, See-saw nystagmus. See-saw nystagmus is a rare disjunctive oscillation associated with parasellar lesions that affect the diencephalon and chiasmal region.

Why is "Congenital pendular nystagmus" not the answer?

Congenital pendular nystagmus is horizontal and present from infancy.

Why is "Convergence-retraction nystagmus" not the answer?

Convergence-retraction nystagmus occurs with attempted upgaze in dorsal midbrain lesions.

Why is "Downbeat nystagmus" not the answer?

Downbeat nystagmus has a downward fast phase and suggests the craniocervical junction.

What concept does this question test?

It tests Neuro-ophthalmology and pupils: see-saw nystagmus in Ophthalmology. It may accompany a bitemporal field loss. Downbeat nystagmus points to a craniocervical junction problem instead.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuro-ophthalmology and pupils: see-saw nystagmus?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.