Periodic complexes and alternating rotatory nystagmus with cyclic pupillary changes

A 69-year-old male, with a history of a previous subdural hematoma, multistroke dementia and ventricular shunting for hydrocephalus, exhibited while comatose isolated periodic alternating rotatory nystagmus with cyclic pupillary changes and periodic alternating gaze. His simultaneous EEG showed PLEDs and subsequently burst-suppression pattern. The latter abnormality was associated, in addition, to transient eyelid opening, synchronized with the EEG bursts. Complex neuro-ophthalmologic clinical signs, sometimes subtle, may be the sole manifestation of EEG periodic complexes that have potential prognostic and therapeutic implications.