To demonstrate eye movement abnormalities of 2 patients with CNS non-germinomatous germ cell tumors.

Patient A is a 42-year-old man with non-germinomatous germ cell tumor and a head MRI obtained at the time of diagnosis in 2003 showed enhancements involving the bilateral ventricles, pineal area and suprasellar region.  He was treated with chemotherapy and craniospinal irradiation and that resulted in a complete response.  But he was left with persistent imbalance and seesaw nystagmus, with slow frequency alternating movements of one eye having elevation/intorsion and the other eye having synchronous depression/extorsion.

Patient B is a 23-year-old man who has a pineal region non-germinomatous germ cell tumor after presenting with obstructive hydrocephalus and Parinaud syndrome with restricted upgaze, convergence retraction nystagmus, eyelid retraction (Collier’s sign) and near-light dissociation.  His hydrocephalus was stabilized with a ventriculoperitoneal shunt.  He underwent 6 cycles of chemotherapy and achieved a radiographic partial response but without resolution of the Parinaud’s syndrome.

See-saw nystagmus is often localized to the rostral midbrain and has been associated with sellar/suprasellar space occupying lesions.  Parinaud syndrome localizes to pretectal lesions and has been associated with pineal region mass lesions with involvement of vertical gaze center in the dorsal midbrain.