Opsoclonus

Description

An Iranian boy aged 15 years presented with a few day's history of abnormal gait and sudden repetitive jerky limbs' movements. The past histories were unremarkable. He was fully conscious. Examination revealed ataxia of stance and gait and generalised myoclonic jerks. Ocular examination revealed opsoclonus (video 1). Routine blood tests and brain MRI with gadolinium were normal. The boy's father stated that he intends to go back to Iran and manage his son there. In Iran, brain MRI, chest/abdomenopelvic CT scans, paraneoplastic autoantibodies panel and CSF analysis were unremarkable. The boy was diagnosed with idiopathic opsoclonus; partially improved on intravenous immunoglobulin.

Video 1

The patient was asked to look forward. Note the repetitive, involuntary, high-amplitude, chaotic and multidirectional conjugate eye movements; these represent opsoclonus (dancing eyes; saccadomania). Opsoclonus is present during fixation, pursuit movements and convergence. In addition, it persists during sleep or eyelid...

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