Journal of Neurology

, Volume 265, Issue 11, pp 2737–2739 | Cite as

Windmill nystagmus in a patient with subacute visual loss

  • Sun-Uk Lee
  • Sung-Yang Jo
  • Hyo-Jung Kim
  • Jeong-Yoon Choi
  • Ji-Soo KimEmail author
Letter to the Editors

Dear Sirs,

Windmill nystagmus is characterized by a clock-like rotation of the direction of nystagmus [1]. Even though various patterns of variant windmill nystagmus have been described [2, 3], the typical pattern of windmill nystagmus has only once been described in a patient with acquired blindness [1]. We report another case of windmill nystagmus that was observed only 3 months after visual loss.

A 47-year-old man was referred for further evaluation of progressive visual loss in both eyes for 3 months. Under the suspicion of atypical optic neuritis, intravenous methylprednisolone, 1 g per day, had been administered for 10 days in another hospital, but his visual acuity had deteriorated.

On examination, he was not able to perceive light in the left eye, and only able to count fingers at 50 cm in the right eye. Both pupils were measured at 5 mm and hardly responded to light or near stimuli. Optic discs were pale in both eyes (Fig. 1a). Video-oculography documented intermittent...


Vertigo Nystagmus Blindness 



This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (no. NRF-2016R1D1A1B04935568).

Compliance with ethical standards

Conflicts of interest

Drs. S.U. Lee, S.Y. Jo, H.J. Kim, and J.Y. Choi report no disclosures. Dr. J.S. Kim serves as an associate editor of Frontiers in Neuro-otology and on the editorial boards of the Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, Journal of Vestibular Research, Journal of Neurology, and Medicine.

Ethical standard

This study followed the tenets of the Declaration of Helsinki, and was performed according to the guidelines of Institutional Review Board of Seoul National University Bundang Hospital (B-1803-459-702).

Supplementary material

The patient shows windmill nystagmus that alternates its direction in the horizontal and vertical planes (WMV 9052 KB)


  1. 1.
    Sanders M, Glaser J (1973) Alternating windmill nystagmus. Neuro-Ophthalmol 7:133–136Google Scholar
  2. 2.
    Choi KD, Shin HK, Kim JS, Kim SH, Choi JH, Kim HJ, Zee DS (2016) Variants of windmill nystagmus. J Neurol 263(7):1375–1381CrossRefGoogle Scholar
  3. 3.
    Cross SA, Smith JL, Norton EW (1982) Periodic alternating nystagmus clearing after vitrectomy. J Clin Neuroophthalmol 2:5–11PubMedGoogle Scholar
  4. 4.
    Leigh RJ, Zee DS (2015) The neurology of eye movements. Oxford University Press, OxfordCrossRefGoogle Scholar
  5. 5.
    Leigh R, Zee DS (1980) Eye movements of the blind. Invest Ophthalmol Vis Sci 19(3):328–331PubMedGoogle Scholar
  6. 6.
    Lee SU, Choi JY, Kim HJ, Kim JS (2018) Recurrent spontaneous vertigo with interictal headshaking nystagmus. Neurology 90(24):e2135–e2145CrossRefGoogle Scholar
  7. 7.
    Kömpf D, Piper H-F (1987) Eye movements and vestibulo-ocular reflex in the blind. J Neurol 234(5):337–341CrossRefGoogle Scholar
  8. 8.
    Prechtl HF, Cioni G, Einspieler C, Bos AF, Ferrari F (2001) Role of vision on early motor development: lessons from the blind. Dev Med Child Neurol 43(3):198–201CrossRefGoogle Scholar
  9. 9.
    Schneider RM, Thurtell MJ, Eisele S, Lincoff N, Bala E, Leigh RJ (2013) Neurological basis for eye movements of the blind. PLoS One 8(2):e56556CrossRefGoogle Scholar
  10. 10.
    Leigh R, Thurston S, Tomsak R, Grossman G, Lanska D (1989) Effect of monocular visual loss upon stability of gaze. Invest Ophthalmol Vis Sci 30(2):288–292PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurologySeoul National University College of MedicineSeoulSouth Korea
  2. 2.Department of Neurology, Dizziness CenterSeoul National University Bundang HospitalSeongnamSouth Korea
  3. 3.Deparment of NeurologyAsan Medical CenterSeoulSouth Korea
  4. 4.Research Administration TeamSeoul National University Bundang HospitalSeongnamSouth Korea

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