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This 60 year old man developed body shakes, severe balance difficulty, and blurred vision over a 1-week period.
You would call this abnormality
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Correct!
The eyes are making conjugate saccades in horizontal, oblique, and vertical planes. The eye movements persist under closed lids. These wild eye movements
have been called “saccadomania.” They arise out of disinhibition of brainstem saccadic generators, but the site of damage is unsettled.
There are four settings for opsoclonus: 1) post-viral encephalitis; 2) paraneoplastic encephalitis; 3) toxic-metabolic crisis; and 4) idiopathic. In children, the paraneoplastic encephalitis results from metastatic neuroblastoma. In adults, it usually results from metastatic small cell lung cancer, but neuroendocrine cancers of many types can cause it.
Opsoclonus never exists in isolation: patients will often also display some combination of impaired thinking, emotional distress, tremor, myoclonus, ataxia, asterixis, and increased deep tendon reflexes.
An evaluation for occult tumor is mandatory. Treatment with corticosteroids and other immune suppressants is aimed at the neurologic manifestations. However, treatment of an underlying neoplasm may be more effective in relieving these manifestations.
If opsoclonus arises as a post-viral phenomenon, it usually resolves within months, but may leave behind permanent ataxia, especially in children. If it arises as a paraneoplastic phenomenon, recovery is even less complete, with survival dependent on the nature of the cancer.
There are four settings for opsoclonus: 1) post-viral encephalitis; 2) paraneoplastic encephalitis; 3) toxic-metabolic crisis; and 4) idiopathic. In children, the paraneoplastic encephalitis results from metastatic neuroblastoma. In adults, it usually results from metastatic small cell lung cancer, but neuroendocrine cancers of many types can cause it.
Opsoclonus never exists in isolation: patients will often also display some combination of impaired thinking, emotional distress, tremor, myoclonus, ataxia, asterixis, and increased deep tendon reflexes.
An evaluation for occult tumor is mandatory. Treatment with corticosteroids and other immune suppressants is aimed at the neurologic manifestations. However, treatment of an underlying neoplasm may be more effective in relieving these manifestations.
If opsoclonus arises as a post-viral phenomenon, it usually resolves within months, but may leave behind permanent ataxia, especially in children. If it arises as a paraneoplastic phenomenon, recovery is even less complete, with survival dependent on the nature of the cancer.