Opsoclonus: Difference between revisions
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{{Differential diagnosis nystagmus}} | {{Differential diagnosis nystagmus}} | ||
==Evaluation== | ==Evaluation== | ||
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==Management== | ==Management== | ||
Revision as of 03:02, 24 November 2016
Background
Opsoclonus is involuntary, irregular multidirectional saccadic eye movements. It occurs at fixed gaze and has been reported with ingestion of many medication overdoses such as organophosphates, lithium, cetirizine, amitryptiline, and diphenhydramine.[1]
Clinical Features
- Multidirectional 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
Work-up
- Glucose check
- Full neuro exam
- TM exam
- CTA or MRA (diagnostic study of choice) of the neck/brain if symptoms consistent with central cause
| Test | Sensitivity |
| HINTS | 100% |
| MRI (24hrs) | 68.40%[2] |
| MRI (48hrs) | 81%[2] |
| CT non con | 26%[3] |
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.
See Also
External Links
References
- ↑ Carstairs S. et al. Opsoclonus Due to Diphenhydramine Poisoning. N Engl J Med 2010; 363:e40
- ↑ 2.0 2.1 http://www.cnsuwo.ca/ebn/downloads/cats/2010/CNS-EBN_cat-document_2010-07-JUL-30_a-negative-dwi-mri-within-48-hours-of-stroke-symptoms-ruled-out-anterior-circulation-stroke_4494E.pdf
- ↑ Chalela JA, Kidwell CS, Nentwich LM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007;369:293–8.