Downbeat nystagmus related with epidural opioid side effect

Summary Background Downbeat nystagmus is a vertical downlook nystagmus associated with craniocervical injury or pharmacological intoxications. Case report We describe a clinical case of a patient who presented with a downbeat nystagmus as the only side effect associated with the use of epidural morphine. The vertical oscillopsia resolved when epidural morphine was withdrawn. Conclusions Downbeat nystagmus is an unfrequent complication but should be considered when utilising perineural morphine anaesthesia. A thorough differential diagnosis should be done previously too.