Parainfectious Opsoclonus

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Identifier 166-6
Title Parainfectious Opsoclonus
Ocular Movements Opsoclonus
Creator Shirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General Hospital
Contributor Primary Shirley H. Wray, MD, PhD, FRCP, Professor of Neurology, Harvard Medical School; Director, Unit for Neurovisual Disorders, Massachusetts General Hospital
Subject Parainfectious Opsoclonus; Saccadic Oscillations
Presenting Symptom Jerky Eyes
History This child was one of a group of children with opsoclonus that I saw with Dr. Cogan in the early 1970's. This boy carries the diagnosis of parainfectious brainstem encephalitis. In the absence of myoclonus, myoclonic encephalopathy often referred to as dancing eyes and dancing feet was ruled out. An occult neuroblastoma or other neural crest tumors in children must always be considered in the differential diagnosis of a child with opsoclonus, particularly if opsoclonus persists. In this case the boy made a spontaneous recovery over several weeks with no reoccurrence. Parainfectious opsoclonus may be due to an infection with: 1. Enterovirus 2. Coxsackie B3 3. Epstein-Barr virus where the presence of a strong intrathecal immune response is associated with high EBV viral titers. Only the results of the EBV serology give a beyond-doubt diagnosis. Parainfectious opsoclonus in adults is reported most frequently as a sequel to a presumed viral infection. Among the 42 cases reviewed by Digre an infection was documented in only 8 cases. (3) These included: 1. Psittacosis 2. Salmonella infection 3. St. Louis encephalitis 4. Rickettsia Conori and 5. Coxsackie viruses B3 and B2 In children, like this boy, parainfectious opsoclonus may follow a prodrome of malaise and mild fever. The organism causing the infection is frequently not identified. The cerebrospinal fluid protein may be mildly elevated and accompanied by a lymphocytic pleocytosis. The illness usually resolves completely in weeks or months. For a complete overview of opsoclonus in childhood, I recommend you review all the cases in this collection. ID 166-4 Neonatal Opsoclonus ID 166-6 Parainfectious Opsoclonus ID 166-12 Opsoclonus in the Dark ID 936-1 Neonatatal Opsoclonus ID 936-8 Paraneoplastic Opsoclonus Downbeat Nystagmus ID 166-12 is shown courtesy of Dr. John Leigh. It is a striking illustration of opsoclonus in the dark. Dr. Leigh made the film to show the rapidity of conjugate multidirectional saccades by placing a light diode on the surface of the eyeball in a patient with opsoclonus. ID 936-8 is a very instructive case, previously published in the New England Journal of Medicine in 1995. The child presented with paraneoplastic opsoclonus due to an occult neuroblastoma. How to investigate a child with opsoclonus is fully outlined in ID936-8. Interested readers are referred to Pediatric Neuro-Ophthalmology. Editors: Brodsky MC, Baker RS, Hamed LM. Spinger-Verlag, New York, Inc. 1996.
Clinical This boy with parainfectious opsoclonus has: • multidirectional saccadic conjugate eye movements • present under closed lids • no ocular flutter
Etiology Parainfectious
Disease/Diagnosis Parainfectious Opsoclonus
Treatment Directed towards the infectious process.
References 1. Cogan DG. Ocular dysmetria: flutter like oscillations of the eyes and opsoclonus. Arch Ophthalmol 1954;51:318-335. 2. Delreux V, Kevers L, Sindic CJM, Callewaert A. Opsoclonus secondary to Epstein-Barr virus infection. Neuroophthalmol 1988;8:179-189. 3. Digre KB. Opsoclonus in adults. Report of three patients and review of the literature. Arch Neurol 1986;43:1165-1175. 4. Dyken P, Kolar O. Dancing eye dancing feet: Infantile polymyoclonia. Brain 1968; 91:305-320. 5. Hankey GJ, Sadka M. Ocular flutter postural body tremulousness and CSF pleocytosis: a rare postinfectious syndrome. J Neurol Neurosurg Psychiatry 1987;50:1235-1236. 6. Hattori T. Hirayama K, Imai T, Yamada T, Kojima S. Pontine lesions in opsoclonus-myoclonus syndrome shown by MRI. J Neurol Neurosurg Psychiatry 1988;51:1572-1575. 7. Kinsbourne M. Myoclonic encephalopathy of infants. J Neurol Neurosurg Psychiatry 1962;25:2712-276. 8. Kuban KC, Ephros MA, Freeman RL, Laffell LB, Bresnan MJ. Syndrome of opsoclonus-myoclonus caused by Coxsackie B3 infection. Ann Neurol 1983;13:69-71. 9. Leigh RJ, Zee DS. Diagnosis of Nystagmus and Saccadic Intrusion. Chp 10:475-558. In: The Neurology of Eye Movements, Fourth Edition. Oxford University Press, NY. 2006. 10. Pranzatelli MR, Tate ED, Travelstead AL, Longee D. Immunologic and clinical responses to rituximab in a child with opsoclonus-myoclonus syndrome. Pediatrics 2005;115:115-119. 11. Shawkat FS, Harris CM, Wilson J, Taylor DSI. Eye movements in children with opsoclonus. Neuropaediatrics 1993;24:218-223. 12. Wiest G, Safoschnik G, Schnaberth G, Mueller C. Ocular flutter and truncal ataxia may be associated with enterovirus infection. J Neurology 1997, 244:288-292.
Relation is Part of 166-3, 166-4, 166-12, 936-1, 936-8
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 1972
Type Image/MovingImage
Format video/mp4
Source 16 mm film
Rights Management Copyright 2002. For further information regarding the rights to this collection, please visit:
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Language eng
ARK ark:/87278/s6wm49zk
Setname ehsl_novel_shw
Date Created 2008-04-15
Date Modified 2017-11-27
ID 188616
Reference URL
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