Continuous vertical ocular flutter, asynchronous palatal myoclonus, and alpha coma

Abstract

A patient is described who suffered a massive brainstem hemorrhage and survived in unreactive alpha coma for eight months. During this time, continuous vertical ocular oscillations were observed and recorded. The eyelids were open and followed the movements of the eyes. Palatal myoclonus was present, along with periodic facial synkinesias and 'ratchet-like' respirations, all of which followed independent rhythms. Review of the literature documented the uniqueness of this association and provided a framework for understanding the relationships among the various phenomena.