Clinical analysis of three cases of ocular flutter-opsoclonus in adults

Abstract

Objective Through an analysis of three cases of ocular flutter-opsoclonus in adults and a review of the relevant literature, we summarized its characteritics to improve the clinical awareness of this sign. Methods Three cases of adult-onset ocular flutter-opsoclonus from July 2014 to July 2017 were retrospectively analyzed in terms of clinical features, cerebrospinal fluid (CSF) analysis, brain imaging, etiologies and treatment, and followed up through telephone calls. Results Case 1: A 68-year-old man presented with ocular flutter, vertigo, myoclonus, ataxia and conscious disturbance. CSF analysis demonstrated pleocytosis and mildly elevated protein level. Brain MR imaging revealed ischemia, and SPECT showed hypoperfusion involving left frontal and occipital lobes. Paraneoplastic syndrome was considered as the etiology. The symptoms subsided without any specific treatment. He died from lung cancer within one year. Case 2: A 66-year-old man presented with ocular flutter, vertigo, ataxia, conscious disturbance and fever. CSF protein level was severely elevated. Brain MR imaging revealed ischemia. Epstein-Barr virus infection was considered as the etiology. The symptoms improved with the administration of antiviral drugs and steroid. Relapse was not observed in the two-year follow-up. Case 3: A 34-year-old woman presented with opsoclonus, oscillopsia, vertigo, ataxia, conscious disturbance and fever. MR imaging showed midbrain lesions. Viral brainstem encephalitis was considered as the etiology. The symptoms improved with the administration of antiviral drugs, steroid, intravenous immunoglobulin and clonazepam. Relapse was not observed in the two-year follow-up. Conclusions Infection and tumors are common etiologies of ocular flutter-opsoclonus. Treatment includes etiological management for infection or tumors and immunosuppressive therapy. The clinical outcomes vary with the underlying etiologies. Key words: Ocular flutter; Opsoclonus; Saccade; Paraneoplastic syndrome