Opsoclonus

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.

Clinical Features

• Multidirectional eye movements when at fixed gaze

Differential Diagnosis

Neurologic Causes

• Benign paroxysmal positional vertigo
• Brain tumors
• ICH
• Lateral medullary syndrome
• Meniere's disease
• Multiple sclerosis
• Stroke
• Wernicke's encephalopathy

Toxicologic

• Alcohol intoxication
• Amphetamines
• Barbiturates
• Benzodiazepines
• Ketamine
• Lithium toxicity
• Other anticonvulsants or sedatives
• Phencyclidine (PCP)
• Phenytoin (Dilantin)
• Salicylates
• SSRI toxicity
• Thiamine deficiency

Management

• Supportive care and treatment focused on the underlying cause of the opsoclonus