Dancing eyes-dancing feet’ Disease

Embed Size (px)

Citation preview

  • 7/29/2019 Dancing eyes-dancing feet Disease

    1/16

    Dancing eyes-dancing feetSyndrome

  • 7/29/2019 Dancing eyes-dancing feet Disease

    2/16

    Presenting Complaint 32y.o male presented with subacute onset of

    nystagmus, myoclonic jerks and ataxia.

  • 7/29/2019 Dancing eyes-dancing feet Disease

    3/16

    History Presenting Complaint Had labyrinthitis for one week nausea and

    vomiting, subjective vertigo, dizziness

    Lying on his right side alleviates symtoms

    Prescribed Prochlorperazine which relieves hissymtoms

    Involuntary muscle and eye movementspronounced insomniac

    Loss of appetite and weight of 1 stone over 1week

  • 7/29/2019 Dancing eyes-dancing feet Disease

    4/16

    Past Medical HistoryAsthma Hayfever

    Bronchitis

  • 7/29/2019 Dancing eyes-dancing feet Disease

    5/16

    Drug History No allergies Prochlorperazine(10mg)-TD

    Never take recreational drugs

    Not taking vaccine recently

  • 7/29/2019 Dancing eyes-dancing feet Disease

    6/16

    General Inspection and Examination Resting tremorAfrebile(36.4C)

    Bradycardia (32 beats/minute)

  • 7/29/2019 Dancing eyes-dancing feet Disease

    7/16

    Neurological examination Cranial nerve examination- Square-wave

    nystagmus (Video 1), reduced pupil size,diplopia, photophobia

    Limbs examination- Generalisedmyoclonus(Video 2), mild spasticity, areflexia,reduced plantar response

    Wide-based ataxic gait,

    Positive Romberg test

  • 7/29/2019 Dancing eyes-dancing feet Disease

    8/16

    Summary 32 y.o male who is on Prochloperazine, presented

    with 3-day history of worsening nystagmus andmyoclonic jerks, preceded by labyrinthithis

  • 7/29/2019 Dancing eyes-dancing feet Disease

    9/16

    Differential diagnoses Cerebellar Disorder Post-infectious Syndrome

    Neoplastic Syndrome

    Side-effect of Prochlorperazine

  • 7/29/2019 Dancing eyes-dancing feet Disease

    10/16

    Investigations FBC-normal U&E-normal

    LFTs-normal

    CSF- IgG Oligoclonal bands, Lymphocyticpleocytosis (99%)

    Viral Serology(blood and CSF)-negative

    Chest X-ray -No abnormality

    MRI-No abnormality

  • 7/29/2019 Dancing eyes-dancing feet Disease

    11/16

    Treatment Symtomatic- Clonazepam(0.5mg TD), Sodium

    Valproate(100mg BD), IV Cyclizine (50mg TD)

    Improved significantly and discharged after 4days

  • 7/29/2019 Dancing eyes-dancing feet Disease

    12/16

    Literature reviewTreatment Number of cases

    IV Immunoglobulin 6

    Anticonvulsant(Clonazepam,Clorazepate)

    5

    Corticosteroid(Prednisolone) 3

    Immunosuppressant(Azathioprine) 1

    Conservative 1Table 1: Treatment of idiopathic Dancing eyes, dancing feet Syndrome

  • 7/29/2019 Dancing eyes-dancing feet Disease

    13/16

    Dancing eyes, dancing feet

    SyndromeA.k.a. Kinsbourne syndrome oropsoclonus-

    myoclonus syndrome Causes

    Idiopathic Post-viral infection-Epstein-Barr, Varicella

    Zoster, enterovirus Neoplastic-breast cancer, sarcoidosis, small-cell

    lung cancer

    Vaccine (Rubella and Human Papillomavirus), Drug( amitriptyline, haloperidol, lithium,

    phenytoin, diazepam, and cocaine)

  • 7/29/2019 Dancing eyes-dancing feet Disease

    14/16

    Take-home message History-taking-ask about recent infection, drug

    and vaccine intake

    Investigation- Chest X-ray and MRI to excludeany underlying malignancy

  • 7/29/2019 Dancing eyes-dancing feet Disease

    15/16

    References 1. Morris E. Opsoclonus-myoclonus. MedLink Neurology. 2006.

    2. Imtiaz K, Vora J. Dancing eyes-dancing feet. Lancet. 1999;354(9176):390.

    3. Candler P, Dale R, Griffin S, Church A, Wait R, Chapman M, et al. Post-streptococcal opsoclonus-myoclonus syndrome associatedwith anti-neuroleukin antibodies. Journal of Neurology, Neurosurgery & Psychiatry. 2006;77(4):507.

    4. Veneselli E, Conte M, Biancheri R, Acquaviva A, De Bernardi B. Effect of steroid and high-dose immunoglobulin therapy onopsoclonus-myoclonus syndrome occurring in neuroblastoma. Medical and pediatric oncology. 1998;30(1):15-7.

    5. Celebisoy N, Akyrekli , Colakoglu Z, Toygar A. Opsoclonus in adults: a report of four cases. Neuro-Ophthalmology.1997;17(1):45-8.

    6. Gwinn K, Caviness J. Electrophysiological observations in idiopathic opsoclonusmyoclonus syndrome. Movement Disorders.1997;12(3):438-42.

    7. Barto A, Pitha J. Opsoclonusmyoclonusdysequilibrium syndrome: cytological and immunological dynamics in the serial

    cerebrospinal fluid in two patients. Journal of neurology. 2003;250(12):1420-5. 8. Glatz K, Meinck H, Wildemann B. Parainfectious opsoclonus-myoclonus syndrome: high dose intravenous immunoglobulins are

    effective. Journal of Neurology, Neurosurgery & Psychiatry. 2003;74(2):279.

    9. Bataller L, Graus F, Saiz A, Vilchez J. Clinical outcome in adult onset idiopathic or paraneoplastic opsoclonus-myoclonus. Brain.2001;124(2):437.

    10. Markakis I, Alexiou E, Xifaras M, Gekas G, Rombos A. Opsoclonus-myoclonus-ataxia syndrome with autoantibodies to glutamicacid decarboxylase. Clinical neurology and neurosurgery. 2008;110(6):619-21.

    11. Pittock S, Lucchinetti C, Lennon V. Anti neuronal nuclear autoantibody type 2: Paraneoplastic accompaniments. Annals ofneurology. 2003;53(5):580-7.

    12. Luque F, Furneaux H, Ferziger R, Rosenblum M, Wray S, Schold Jr S, et al. Anti Ri: An antibody associated with paraneoplasticopsoclonus and breast cancer. Annals of neurology. 1991;29(3):241-51.

    13. Lapenna F, Lochi L, de Mari M, Iliceto G, Lamberti P. Post-vaccinic opsoclonus-myoclonus syndrome: a case report. Parkinsonism& Related Disorders. 2000;6(4):241-2.

    14. McCarthy J, Filiano J. Opsoclonus Myoclonus after human papilloma virus vaccine in a pediatric patient. Parkinsonism & RelatedDisorders. 2009;15(10):792.

    15. Wong A, Musallam S, Tomlinson R, Shannon P, Sharpe J. Opsoclonus in three dimensions: oculographic, neuropathologic andmodelling correlates. Journal of the neurological sciences. 2001;189(1-2):71-81.

    16. Helmchen C, Rambold H, Sprenger A, Erdmann C, Binkofski F. Cerebellar activation in opsoclonus: an fMRI study. Neurology.2003;61(3):412.

  • 7/29/2019 Dancing eyes-dancing feet Disease

    16/16

    Acknowledgment