Periodic Alternating Nystagmus

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Abstract
To the Editor.—Recently, Keane described periodic alternating nystagmus (PAN) associated with down-beating nystagmus in a 54-year-old woman with demyelinating disease, who had undergone autopsy (Arch Neurol 30:399, 1974). It was suggested that the pertinent lesion lay in the vestibular nuclei along the floor of the fourth ventricle, although other sites of demyelination involved the periaqueductal gray matter, both medial longitudinal fasciculi, both restiform bodies, and the spinal cord. The following case of PAN in an 11-yearold girl was associated with unilateral seeding by astrocytoma cells in the vestibular nuclei at the pontomedullary level. Report of a Case.—An 11-year-old girl had a left frontal astrocytoma partially resected, followed by radiation therapy and administration of vincristin. Eleven months later she was cachectic and had a spastic quadriparesis. The left pupil was 1 mm larger than the right, and both were briskly reactive. Nystagmus was present with the following characteristics.

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