Postintervention acute opsoclonus myoclonus syndrome

Abstract

Opsoclonus myoclonus syndrome (OMS) is a rare, neurological condition affecting 1 in 10 000 000 people annually. Opsoclonus, defined as involuntary rapid, multivectorial oscillations of the eyes, together with ataxia and myoclonus are usually present. OMS may be paraneoplastic: often associated with occult neuroblastoma in childhood and with breast carcinoma or small cell lung carcinoma in adults. Other aetiologies include viral or toxic agents. The pathogenesis is thought to be immune mediated. A 37-year-old woman with previous inflammatory cranial mononeuropathies was admitted for elective dilatation and curettage (D&C). Immediately after she complained of left-sided paraesthesia and later became disoriented, with incoherent speech, inability to obey commands, opsoclonus of the eyes and myoclonic jerks. Investigations including onconeuronal antibodies, cerebrospinal fluid analysis, and imaging were normal. She was treated with intravenous methylprednisolone with rapid improvement. Previous surgeries with anaesthesia were uncomplicated. The anaesthetic agents used for the D&C were fentanyl and propofol.

Paraneoplastic opsoclonus-myoclonus syndrome as a rare presentation of parotid adenocarcinoma

“…POMA is a rare autoimmune neurological paraneoplastic syndrome that arises from the distant effects of a tumor. Nevertheless, it is crucial to differentiate it from other neurological manifestations related to metastasis, infection, ischemia, and metabolic disturbances [5,6]. To achieve this, a comprehensive medical history is necessary to identify risk factors, clinical complaints and conduct a thorough physical examination [6].…”

“…Nevertheless, it is crucial to differentiate it from other neurological manifestations related to metastasis, infection, ischemia, and metabolic disturbances [5,6]. To achieve this, a comprehensive medical history is necessary to identify risk factors, clinical complaints and conduct a thorough physical examination [6]. Despite the unclear pathogenic mechanisms of POMA, specific tumor types have been linked to wellcharacterized anti-neural antibodies [7,8].…”

“…It often presents as a paraneoplastic syndrome, where a cancer remote from the brain induces cerebellar dysfunction unrelated to metastases [1][2][3]. In most adults with opsoclonus-myoclonus, the etiologies can be neoplastic, infectious, metabolic, or idiopathic in nature [5,6]. The symptoms of cerebellar dysfunction in the case presented include opsoclonus, myoclonus, and ataxia, which has led to its colloquial name, "dancing eyes, dancing feet syndrome".…”

“…The pathogenesis is thought to be immune-mediated based on the paraneoplastic nature of the syndrome and its symptomatic response to immunosuppressive therapy. Therapeutic benefit has been described with the use of steroids, intravenous immunoglobulins, cyclophosphamide, azathioprine, and rituximab [4][5][6]. The prognosis of OMS depends on early management and successful treatment, highlighting the importance of promptly identifying the syndrome and its underlying cause [7,8].…”

Phencyclidine: A rare cause of saccadic intrusions

“…Opsoclonus is similar to ocular flutter; however, it is multidirectional. [23] Ocular flutter/opsoclonus, in adults, may be a manifestation of a paraneoplastic or parainfectious condition though, uncommonly, it may be caused by a structural lesion (e.g., pontine hemorrhage or multiple sclerosis) or drug intoxication. [24]…”