Periodic Alternating Nystagmus With Downward Beating Nystagmus

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Abstract
A 54-year-old woman with a devastating ten-month course of demyelinating disease exhibited periodic alternating nystagmus that gradually was replaced by prominent downward beating nystagmus. Multiple bilateral irregular shallow areas of demyelination scattered along the floor of the fourth ventricle, involving portions of all vestibular nuclei, are the probable cause of her unusual nystagmus.