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Title

Diplopia : Jump for Joy

Purpose	To illustrate the value of testing ocular saccades in diplopia patients with subtle deficits of smooth pursuit.
Methods	Series of 3 case reports.
Results	Three patients with diplopia and very subtle - if any- smooth pursuit deficits were found to have prominent saccadic abnormalities. A 41 year old patient with vertical diplopia had extreme difficulty to initiate vertical upward saccades in the presence of Collier lid retraction sign and pupillary light/near dissociation. This was explained by compression of the posterior commissure due to a pineal germinoma causing a dorsal midbrain/ Parinaud syndrome. A 71 year old patient presenting with subtle vertical diplopia was found to have marked slowing of downward saccades due to a bilateral paramedian thalamic infarct. Finally, a 44 year old otherwise healthy patient presenting with horizontal diplopia showed slowing of adduction saccades of the right eye and nystagmus on abduction in the contralateral eye. Cerebral imaging revealed a demyelinating lesion at the level of the right medial longitudinal fasciculus at the dorsal pons causing a right internuclear ophthalmoplegia.
Conclusion	Testing ocular saccades can provide valuable information and should be an inherent part of a comprehensive ocular motility examination. Slowing of saccades confined to the horizontal plane suggests pontine disease, whereas slowing confined to the vertical plane suggests dysfunction at the level of the thalamo-mesencephalic junction or the midbrain.
Conflict of interest	No

Authors 1

Last name	RACHDI
Initials	M
Department	CHU Saint-Pierre et Brugmann
City	Bruxelles

Authors 2

Last name	Buelens
Initials	T
Department	CHU Saint-Pierre et Brugmann
City	Bruxelles