Editors' note: Clinical Reasoning: A 54-year-old woman with confusion and visual disturbances

Abstract

Rossi et al. presented the unusual case of a 54-year-old woman with cirrhosis who developed oculomotor apraxia, optic ataxia, impaired smooth pursuit, and horizontal nystagmus in all directions of gaze. The neuroimaging and electrographic diagnosis was nonconvulsive status epilepticus resulting in Balint syndrome. Dr. Pollak also suspects an epileptic origin of the horizontal, alternating nystagmus pattern, given the bilateral MRI and EEG findings. However, Dr. Pollack notes that a normal optokinetic nystagmus would be unusual during seizure activity. Rossi et al. attribute this to the fluctuating nature of the patient's condition and the intermittent epileptiform activity on EEG. Resolution of the cortical diffusion abnormalities on MRI would also have supported seizures as the cause of the patient's symptoms, as Dr. Pollak writes. Unfortunately, this could not be confirmed as the patient was lost to follow-up. IRossi et al. presented the unusual case of a 54-year-old woman with cirrhosis who developed oculomotor apraxia, optic ataxia, impaired smooth pursuit, and horizontal nystagmus in all directions of gaze. The neuroimaging and electrographic diagnosis was nonconvulsive status epilepticus resulting in Balint syndrome. Dr. Pollak also suspects an epileptic origin of the horizontal, alternating nystagmus pattern, given the bilateral MRI and EEG findings.