Ocular Flutter and Opsoclonus

Abnormal repetitive eye movements in which the fast phase or saccades are abnormal include ocular flutter and opsoclonus. Opsoclonus is a continuous succession of multidirectional conjugate saccadic eye movements with no intersaccadic interval. In the acute stage, it is usually associated with violent ataxia and high-amplitude tremor of all limbs. As recovery occurs, some patients go through a phase in which there are spontaneous bursts of horizontal back-to-back saccades, again without intersaccadic interval. In adults, opsoclonus usually results from brain stem encephalitis, either sporadic or as a remote effect of carcinoma. In infants and children, opsoclonus can be a remote manifestation of neuroblastoma. Ocular flutter comprises bursts of saccades in one plane, typically horizontal, during forward fixation. There are no intervals between saccades. Patients can manifest ocular flutter when developing or recovering from opsoclonus, and both disorders probably share pathophysiological mechanisms. Multiple sclerosis, hydrocephalus, head trauma, midbrain glioblastoma, thalamic hemorrhage, and sialidosis (cherry-red spot--myoclonus syndrome) have all been reported in association with ocular flutter. y

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