Our patient may have suffered microscopic structural damage to saccadic burst neurons or Purkinje cells, precipitating flutter. In our case, OF occurred immediately after mild head trauma and no other cause was identified.
#Ocular flutter free
In the cerebellar model, dysfunctional Purkinje cells are incapable of inhibiting neurons in the fastigial nucleus, thereby reinforcing OPN inhibition and allowing saccadic burst neurons to be free to oscillate ( 1). In the brainstem model, saccadic oscillations are thought to arise from altered membrane properties of saccadic burst neurons that affect their interaction with omnipause neurons (OPN). Idiopathic OF also has been reported ( 1).Īlthough the pathophysiology of OF remains uncertain, theories have been proposed involving the brainstem and the cerebellum. Paraneoplastic antibodies also may cause OF with neuroblastoma most commonly implicated in children, whereas small cell lung cancer and breast cancer are most commonly involved in adults. OF is associated with a wide range of disorders of the central nervous system including encephalitis, myoclonic encephalopathy of infants, toxic metabolic states, and demyelinating disease. An important differential to consider is voluntary nystagmus which, unlike OF, is usually not sustained for more than 30 seconds ( 1). Diagnosis can be made clinically and/or confirmed with eye recordings. OF and opsoclonus are eye movement abnormalities consisting of back-to-back saccades without an intersaccadic interval, differentiating them from nystagmus and other types of saccadic intrusions. 1.:Ĭalibrated 1-second horizontal profile (only one eye shown but all eye movements were conjugate). Over a period of 1 year, the symptoms gradually improved with less severe and frequent episodes.
#Ocular flutter trial
A trial of gabapentin was prescribed but this was not tolerated. The episode continued for approximately 45 minutes. Superimposed on these were conjugate, high-frequency, high-amplitude, back-to-back horizontal saccadic movements with no intersaccadic intervals ( Figs. This initially was diagnosed as voluntary nystagmus.Įye movement recordings during an episode showed fixation instability with saccadic intrusions. The episodes of oscillopsia continued intermittently, exacerbated by fatigue, without relieving factors and would resolve spontaneously within a few hours. A brain MRI and studies for paraneoplastic antibodies were normal.
The patient recalled the event of her head trauma and did not suffer amnesia. There was no myoclonus, ataxia, or signs of cerebellar dysfunction. Her eye examination was normal except for intermittent ocular flutter (OF) and, at times, opsoclonus. She had no family medical history of note.
#Ocular flutter full
She was born at full term and her general development during childhood was unremarkable. She lost consciousness for a few minutes and, on regaining consciousness, immediately became aware of blurred vision with oscillopsia. A 13-year-old girl, previously healthy with no visual complaints, fell off a playground roundabout onto a concrete surface.
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