Opsoclonus: Difference between revisions
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==Background== | ==Background== | ||
*Definition: involuntary, irregular multidirectional saccadic eye movements.<ref> Carstairs S. et al. Opsoclonus Due to Diphenhydramine Poisoning. N Engl J Med 2010; 363:e40</ref> | |||
*Occurs at fixed gaze and has been reported with various medication overdoses such as [[organophosphates]], [[lithium]], cetirizine, amitryptiline, and [[diphenhydramine]].<ref> Carstairs S. et al. Opsoclonus Due to Diphenhydramine Poisoning. N Engl J Med 2010; 363:e40</ref> | |||
==Clinical Features== | ==Clinical Features== | ||
*Multidirectional eye movements when at fixed gaze | *Multidirectional involuntary eye movements when at fixed gaze | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Differential diagnosis nystagmus}} | {{Differential diagnosis nystagmus}} | ||
==Evaluation== | ==Evaluation== | ||
Evaluation for symptoms of [[vertigo]], [[CVA]], and due to the association with medication overdoses, a psychiatric screening is worth consideration | |||
#Glucose check | |||
#Full neuro exam | |||
#TM exam | |||
#CTA or MRA (diagnostic study of choice) of the neck/brain if symptoms consistent with central cause | |||
==Management== | ==Management== | ||
*Supportive care and treatment focused on the underlying cause of the opsoclonus | |||
==Disposition== | ==Disposition== | ||
Generally patients are admitted if the etiology is due to an overdose and further supportive care and psychiatric monitoring is required. | |||
==See Also== | ==See Also== | ||
*[[Dizziness]] | |||
*[[EBQ:HINTS_Exam]] | |||
*[[Cerebellar Stroke]] | |||
*[[Stroke syndromes]] | |||
*[[Vertigo]] | |||
==External Links== | ==External Links== | ||
*[http://www.nejm.org/doi/full/10.1056/NEJMicm1002035 NEJM Opsoclonus ] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Ophthalmology]] [[Category:Toxicology]] | |||
Latest revision as of 23:40, 17 November 2021
Background
- Definition: involuntary, irregular multidirectional saccadic eye movements.[1]
- Occurs at fixed gaze and has been reported with various medication overdoses such as organophosphates, lithium, cetirizine, amitryptiline, and diphenhydramine.[2]
Clinical Features
- Multidirectional involuntary eye movements when at fixed gaze
Differential Diagnosis
Neurologic Causes
Toxicologic
- Alcohol intoxication
- Amphetamines
- Barbiturates
- Benzodiazepines
- Ketamine
- Lithium toxicity
- Other anticonvulsants or sedatives
- Phencyclidine (PCP)
- Phenytoin (Dilantin)
- Salicylates
- SSRI toxicity
- Thiamine deficiency
Evaluation
Evaluation for symptoms of vertigo, CVA, and due to the association with medication overdoses, a psychiatric screening is worth consideration
- Glucose check
- Full neuro exam
- TM exam
- CTA or MRA (diagnostic study of choice) of the neck/brain if symptoms consistent with central cause
Management
- Supportive care and treatment focused on the underlying cause of the opsoclonus
Disposition
Generally patients are admitted if the etiology is due to an overdose and further supportive care and psychiatric monitoring is required.