Ocular bobbing and opsoclonus: two abnormal spontaneous eye movements occurring in the same patient: case report

The movement disorder of adult opsoclonus

We present three cases of the adult opsoclonus-myoclonus syndrome in patients with systemic carcinoma. In addition to opsoclonus and myoclonus, other clinical components of the syndrome can include ataxia, tremor, gait and stance dysfunction, altered mental status, and head and face dyskinesias. The most common etiologies are idiopathic, paraneoplastic, and infectious encephalitis. Radiographic and pathological studies suggest brain-stem dysfunction with associated cerebellar and/or cerebellar pathway dysfunction. In many cases, there is evidence for the involvement of immunologic and/or inflammatory processes in the pathogenesis of this syndrome. The timely recognition of this syndrome is important because of its implications for the underlying etiology and prognosis. The appearance of this syndrome should prompt the search for an occult malignancy.

Transient opsoclonus in organophosphate poisoning

Opsoclonus transiently occurred in the acute stage of combined parathion and methyl-parathion poisoning. Despite persistent cholinesterase inhibition this symptom subsided spontaneously. This observation provides strong evidence for cholinergic pathways being reversibly involved in isolated opsoclonus.

The clinical spectrum of ocular bobbing and ocular dipping

The term "ocular bobbing" defines a distinctive class of abnormal spontaneous vertical eye movements which occur in a variety of clinicopathological settings. Four cardinal forms, which correspond to the predicted permutations of the two characteristic clinical variables, initial vertical excursion and phasic velocity, have now been described. Reverse ocular dipping, with directional reversal and phasic inversion from typical ocular bobbing, is the last link in this functional tetrad and is newly presented. The four pathological forms share several basic phenomenological features but exhibit clinical and aetiological diversity and significant differences in prognosis. An analysis of the clinical spectrum of disorders subsumed under the general heading of "ocular bobbing" is presented.

Recovery from primary pontine hemorrhage

A patient with primary pontine hemorrhage showed typical ocular bobbing with only mild alteration of mental status. Serial CT scans showed resolution of the hemorrhage and correlated with clinical improvement.

Ocular bobbing with survival

A case is described of prolonged ocular bobbing with survival after subarachnoid haemorrhage from a pontine arteriovenous malformation. Hitherto, this sign has usually been associated with a rapidly fatal outcome.

An electro-oculographic study of ocular bobbing and intermittent vertical oscillations occuring in the same patient

A surviving patient with two rare types of abnormal eye movements, typical ocular bobbing and subsequently developed intermittent vertical oscillations of the eyes, is described, and a follow-up series of electro-oculographic recordings of these eye movements is analyzed. It is suggested that these two types of vertical eye movements might have a common pathophysiological background and the activity of remaining functional oculomotor pathways may play an important role in their occurrence.