ABSTRACT
Background: Isolated myoclonus and opsoclonus myoclonus ataxia syndrome (OMAS) as an initial manifestation of the coronavirus disease 2019 (COVID-19) has not yet been described. Case History: A 55-year-old right-handed Hispanic woman, with no history of neurological dysfunction, was asymptomatic without fever, headaches, respiratory symptoms, myalgia or chemosensory dysfunction until four days prior to presentation when she gradually lost muscle control with uncontrollable arrhythmic nonrepetitive jerking and shaking throughout, involving her abdomen, arms, face and hands both with intention and at rest. Later that same day, she observed oscillopsia, whereby her visual field flickered vertically. On the fourth day after onset of symptoms, the patient's COVID-19 RT-PCR on nasopharyngeal swab test was positive. Physical examination on day five: Afebrile. Cranial Nerve (CN) examination: CN III, IV, VI: Opsoclonus, spontaneous conjugate multidirectional eye movements without nystagmus and intersaccadic interval not restricted to a horizontal or vertical gaze. CN VII: Intermittent rapid closing and fluttering of eyelids. Gait: Unable to stand. Cerebellar examination: Finger-to-nose testing: Severe intention myoclonus. Myoclonic jerks were present on drift testing with inability to raise the arms due to upwards and negative myoclonic movements. Negative myoclonus on wrist extension. Lumbar puncture on day five: WBC count: 2 cells/mL, RBC count: 0 cells/mL, protein 26 mg/dl, gram stain negative, viral serology negative. Discussion: Those who present with myoclonus, oscillopsia, ataxia or opsoclonus without preexisting respiratory or chemosensory symptoms warrant evaluation for presence of COVID-19 infection.