Reversible periodic alternating gaze deviation in hepatic encephalopathy.

We report two patients with hepatic encephalopathy who developed periodic alternating gaze deviation (PAGD). Neither patient had an evident structural lesion, and the PAGD subsided after treatment of the encephalopathy. We postulate that a GABA-mediated disturbance affecting the cerebellar nodulus and uvula was responsible for the PAGD in these patients.