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Upbeat nystagmus in anti-Ma2 encephalitis
  1. Pablo Garcia-Reitboeck1,
  2. Graham Thompson2,
  3. Paul Johns3,
  4. Yasir Al Wahab3,
  5. Salah Omer1,
  6. Colette Griffin1
  1. 1Atkinson Morley Neuroscience Unit, St George's Hospital, London, UK
  2. 2Moorfields Eye Unit, St. George's Hospital, London, UK
  3. 3Department of Pathology, St George's Hospital, London, UK
  1. Correspondence to Dr Pablo Garcia-Reitboeck, Atkinson Morley Neuroscience Unit, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK; pgarciareitboeck{at}


Anti-Ma2 encephalitis is a paraneoplastic disorder characterised by brainstem and/or limbic involvement. Eye movement abnormalities can occur in this condition, often with confusion or somnolence. We describe a patient with progressive oscillopsia (with upbeat nystagmus) and unsteadiness, followed by acute pancreatitis. She did not respond to immunomodulatory treatment and subsequently died of complications related to pancreatitis and sepsis. There was no tumour identified at autopsy, but the anti-Ma2 antibodies in her serum and the discovery of a brainstem-predominant inflammatory infiltrate at autopsy strongly suggest a paraneoplastic disorder. Our case illustrates that upbeat nystagmus can be a predominant feature in anti-Ma2 encephalitis; clinicians should consider testing for anti-Ma2 antibodies in patients with upbeat nystagmus of unknown cause.

  • Eye Movements
  • Paraneoplastic Syndrome
  • Clinical Neurology
  • Neuropathology

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