We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Images in Neurology |

Inverse Ocular Bobbing in a Patient With Encephalitis Associated With Antibodies to the N-methyl-D-aspartate Receptor

Haruo Shimazaki, MD, PhD; Mitsuya Morita, MD, PhD; Imaharu Nakano, MD, PhD; Josep Dalmau, MD, PhD
Arch Neurol. 2008;65(9):1251. doi:10.1001/archneur.65.9.1251.
Text Size: A A A
Published online


A 30-year-old woman presented with headache, fever, disorientation, and recent memory disturbance. Brain magnetic resonance imaging showed fluid-attenuated inversion recovery hyperintense abnormalities in both hippocampi, without abnormal findings in other areas of the brain or brainstem.1 The patient subsequently developed tonic convulsions, restlessness, anxiety, and hypoventilation that led to the use of sedation and mechanical ventilation. While in the intensive care unit, inverse ocular bobbing and skew deviation were transiently observed (Figure) (a video is available here). Antibodies to NR1/NR2 heteromers of the N-methyl-D-aspartate receptor were identified in her serum and cerebrospinal fluid. After immunotherapy and removal of an ovarian teratoma, all symptoms started to improve and the patient was able to return to her job 1 year later.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption

The position of the patient's eyes showed skew deviation when the inverse ocular bobbing resolved.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

5 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections