Acute Upgaze Deviation
Sudden involuntary upgaze of both eyes
May be episodic or sustained
Common causes: syncope, seizure, dystonic reaction to neuroleptics (“oculogyric crisis”), isolated benign developmental disorder in otherwise normal neonates
Uncommon causes: habit spasm (tic disorder), carbamazepine toxicity, hypoxic encephalopathy
Core neuro-ophthalmic feature
Upgaze of both eyes of variable duration
Possible accompanying clinical features
Recent exposure to neuroleptic agents or carbamazepine, evoking an “oculogyric crisis”
Dystonic facial and/or extremity postures, forced thoughts or emotions as part of an “oculogyric crisis”
Involuntary movements of the face or extremities called “habit spasms” or “tic disorder”
Tonic–clonic extremity movements as part of a seizure
Flapping wrist flexion tremor (“asterixis”) in hypoxic-ischemic, post-infectious, paraneoplastic, or metabolic encephalopathy
Ocular bobbing in hypoxic-ischemic encephalopathy or metabolic encephalopathy
No accompanying clinical manifestations when this is a developmental disorder in normal neonates
Imaging features
Usually normal
Multifocal cerebral, brainstem, cerebellar restricted diffusion in hypoxic-ischemic encephalopathy
Brainstem signal abnormalities in ocular bobbing
Psychogenic upgaze deviation
Look for accompanying manifestations in order to make an organic diagnosis
Depends on the underlying condition
Should resolve within months if this is an isolated manifestation in otherwise normal neonates
