| Identifier |
162-4 |
| Title |
Ocular Flutter |
| Creator |
Shirley H. Wray, MD, PhD, FRCP |
| Affiliation |
(SHW) Professor of Neurology, Harvard Medical School; Director, Unit for Neurovisual Disorders, Massachusetts General Hospital, Boston, Massachusetts |
| Subject |
Idiopathic Ocular Flutter |
| History |
This little boy complained of difficulty focusing. On examination he was found to have ocular flutter. He was otherwise neurologically intact and in good general health. Investigations were directed to rule out 1. Neuroblastoma (see ID 936-8) 2. Enterovirus infection 3. Parainfectious process (See ID166-6) 4. Multiple sclerosis (See ID166-2) 5. Meningitis 6. Accidental drug toxicity - All studies were negative. A full diagnostic work up ruled out a neuroblastoma. A spinal tap showed normal cerebrospinal fluid. Differential diagnosis considered was: 1. Convergence-initiated voluntary flutter and 2. Idiopathic ocular flutter In 1954 Cogan first used the term "ocular flutter" to describe a rare disorder of horizontal eye movements characterized by rapid bursts of synchronous back-to-back horizontal oscillatory movements usually seen in the primary position of gaze. Since then, there have been over 50 reports, usually single cases or small series, linking the phenomenon to a wide variety of brainstem and cerebellar conditions, e.g. post enteroviral infection, cerebral malaria, cyclosporine treatment and meningitis, but perhaps most frequently associated with parainfectious states or, with opsoclonus, as a paraneoplastic manifestation of occult malignancy. Convergence-initiated voluntary flutter is a normal intrinsic capability in man and is often accompanied by facial grimacing or eyelid flutter. Voluntary flutter is usually not well sustained in contrast to pathologic flutter which is more sustained irrespective of the patient's vergence state. Idiopathic ocular flutter should only be diagnosed when all other potential etiologies have been ruled out by appropriate investigations. |
| Anatomy |
See ID166-2 |
| Disease/Diagnosis |
Ocular Flutter |
| Clinical |
This boy with idiopathic ocular flutter has: • Sustained horizontal saccadic oscillations without an intersaccadic interval characteristic of pathologic ocular flutter (SeeTable 10-8 Etiology of ocular flutter and opsoclonus (6)). |
| Presenting Symptom |
Blurred vision |
| Ocular Movements |
Ocular Flutter |
| Neuroimaging |
See ID166-2 |
| Treatment |
N/A |
| Etiology |
Idiopathic |
| Date |
1974 |
| References |
1. Ashe J, Hain TC, Zee DS, Schatz NJ. Microsaccadic flutter. Brain 1991;114:461-472. http://www.ncbi.nlm.nih.gov/pubmed/2004251 2. Cogan DG. Ocular dysmetria: flutter like oscillations of the eyes and opsoclonus. Arch Ophthalmol 1954;51:318-335. http://www.ncbi.nlm.nih.gov/pubmed/13123617 3. Foroozan R, Brodsky MC. Microsaccadic opsoclonus: an idiopathic cause of oscillopsia and episodic blurred vision. Am J Ophthalmol 2004;138:1053-1054. http://www.ncbi.nlm.nih.gov/pubmed/15629305 4. Hotson JR. Convergence-initiated voluntary flutter: a normal intrinsic capability in man. Brain Res 1984;294:299-304. http://www.ncbi.nlm.nih.gov/pubmed/6704727 5. Houtman WA, Roze JH, Scheper W. Vertical vergence movements. Doc Ophthalmol 1981;51:199-207. http://www.ncbi.nlm.nih.gov/pubmed/7285769 6. Leigh JR, Zee DS. Diagnosis of Nystagmus and Saccadic Intrusion. Chp 10:475-558. In: The Neurology of Eye Movements 4th Edition. Oxford University Press, NY 2006. 7. Shawkat FS, Harris CM, Wilson J, Taylor DSI. Eye movements in children with opsoclonus. Neuropaediatrics 1993;24:218-223. http://www.ncbi.nlm.nih.gov/pubmed/8232781 8. Yee RD, Spiegel PH, Yamada T, Abel LA, Zee DS. Voluntary saccadic oscillations resembling ocular flutter and opsoclonus. J Neuro-ophthalmol 1994;14:95-101. http://www.ncbi.nlm.nih.gov/pubmed/7951936 9. Zee DS, FitzGibbon EJ, Optican LM. Saccade-vergence interactions in humans. J Neurophysiol 1992;68:1624-1641. http://www.ncbi.nlm.nih.gov/pubmed/1479435 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Source |
16mm tape |
| Relation is Part of |
166-1, 166-2, 166-6, 936-1, 936-7 |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Shirley H. Wray Collection: https://novel.utah.edu/Wray/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2002. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s69051b3 |
| Setname |
ehsl_novel_shw |
| ID |
188582 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s69051b3 |
