ABSTRACT
Objective Through an analysis of three cases of ocular flutter-opsoclonus in adults and a review of the relevant literature,we summarized its characteritics to improve the clinical awareness of this sign.Methods Three cases of adult-onset ocular flutter-opsoclonus from July 2014 to July 2017 were retrospectively analyzed in terms of clinical features,cerebrospinal fluid (CSF) analysis,brain imaging,etiologies and treatment,and followed up through telephone calls.Results Case 1:A 68-year-old man presented with ocular flutter,vertigo,myoclonus,ataxia and conscious disturbance.CSF analysis demonstrated pleocytosis and mildly elevated protein level.Brain MR imaging revealed ischemia,and SPECT showed hypoperfusion involving left frontal and occipital lobes.Paraneoplastic syndrome was considered as the etiology.The symptoms subsided without any specific treatment.He died from lung cancer within one year.Case 2:A 66-year-old man presented with ocular flutter,vertigo,ataxia,conscious disturbance and fever.CSF protein level was severely elevated.Brain MR imaging revealed ischemia.Epstein-Barr virus infection was considered as the etiology.The symptoms improved with the administration of antiviral drugs and steroid.Relapse was not observed in the two-year follow-up.Case 3:A 34-year-old woman presented with opsoclonus,oscillopsia,vertigo,ataxia,conscious disturbance and fever.MR imaging showed midbrain lesions.Viral brainstem encephalitis was considered as the etiology.The symptoms improved with the administration of antiviral drugs,steroid,intravenous immunoglobulin and clonazepam.Relapse was not observed in the two-year follow-up.Conclusions Infection and tumors are common etiologies of ocular flutter-opsoclonus.Treatment includes etiological management for infection or tumors and immunosuppressive therapy.The clinical outcomes vary with the underlying etiologies.
ABSTRACT
Ocular flutter is a relatively rare eye movement disorder that refers to occasional bursts of involuntary horizontal oscillation around the point of fixation, characterized by rapid, repetitive, horizontal, symmetrical and sinusoidal oscillation without inter- saccadic interval. It is known to be associated with disorders of the cerebellum and brainstem resulting from various pathological conditions, but it's anatomical and pathophysiological basis remains unclear. Here, we present the case of a patient who had severe ocular flutter associated with Merkel cell carcinoma.
Subject(s)
Humans , Brain Stem , Carcinoma, Merkel Cell , Cerebellum , Ocular Motility Disorders , Paraneoplastic SyndromesABSTRACT
Hashimoto's encephalopathy is a neurological disorder associated with high titers of antithyroid antibodies. The common neurologic symptoms are seizure, stroke-like episode, or mental change. However other atypical presentations, such as aphasia, myoclonus, ataxia, and cognitive dysfunction have also been described. We report hear a 44-year-old woman with Hashimoto's encephalopathy. The patient presented with ocular flutter as a principal manifestation, which is rare in Hashimoto's encephalopathy.
Subject(s)
Adult , Female , Humans , Antibodies , Aphasia , Ataxia , Myoclonus , Nervous System Diseases , Neurologic Manifestations , SeizuresABSTRACT
Ocular flutter is a rare, horizontal eye movement disorder characterized by rapid saccadic oscillations. Previous reports have presented a relationship between ocular flutter syndrome and many conditions/diseases. However, it is surprising that there have been few reported cases in which there has been a clear anatomically localized lesion linked to ocular flutter. So the pathophysiological basis for ocular flutter syndrome is not understood yet. We have recently experienced a case of ocular flutter syndrome where the ocular flutter was associated with dysmetria, dysdiadochokinesia, kinetic predominant tremor, and ataxia. The prodromal symptoms, self-limited illness course and cerebrospinal fluid (CSF) pleocytosis of our case suggest an infectious aetiology for this syndrome. Although most of the sequelae of infectious diseases represent more diffuse involvement of the nervous system, the predominant cerebellar symptoms and signs associated with ocular flutter imply that the single responsible lesion of the present case might have been related to the cerebellum-associated neural circuits. Brain single photon emission computed tomography (SPECT) in the present case showed perfusion decrease in the left thalamus. The present case suggests that the cerebellar output circuit (dorsal vermis-fastigial nucleus-vestibular nucleus-thalamus-cortex) might be related to the occurrence of ocular flutter. The description of this case may improve the understanding of the pathological mechanisms of ocular flutter syndrome.