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A 52-year-old woman with abnormal eye movements

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Presentation on theme: "A 52-year-old woman with abnormal eye movements"— Presentation transcript:

1 A 52-year-old woman with abnormal eye movements
Teaching NeuroImages Neurology Resident and Fellow Section © 2017 American Academy of Neurology

2 Vignette 52-year-old woman with Parkinson’s disease since age 42 on carbidopa/levodopa 25/250 five times/day developed “offs” characterized by left foot dystonia. After adding rasagiline 1mg/day, multi-hour episodes of gaze deviation, anxiety, retrocollis, and dyskinesias ensued. Symptoms, marginally improved with diphenhydramine, resolved when levodopa was held temporarily. These episodes didn’t recur after discontinuation of rasagiline (video 1) Davis, et al. © 2017 American Academy of Neurology

3 Imaging Davis, et al. Video Legend:
This episode of forced left upward gaze deviation is directed toward the side most affected with parkinsonism and lasted 6.5 hours. This oculogyric crisis began 30 min after her last dose of carbidopa/levodopa 25/250 and rasagiline 1mg. Note the accompanying anxiety, retrocollis, right torticollis, tachypnea, and generalized dyskinesias. Davis, et al. © 2017 American Academy of Neurology

4 Oculogyric Crisis in Treated Parkinson’s Disease: A Video Case
Typical oculogyric crisis lasting hours with accompanying psychiatric features is rare in Parkinson’s disease (1,2). It’s more commonly associated with dopamine blockers, post- encephalitic parkinsonism and disorders of dopamine metabolism (1). Levodopa-induced ocular dyskinesia with forced upward lateral gaze, toward side most affected by parkinsonism, last seconds (2). Slow EJ, Lang AE. Oculogyric Crises: A Review of Phenomenology, Etiology, Pathogenesis, and Treatment 2017;32:2: 2. Grotzsch H, Sztajzel R, Burkhard PR. Levodopa-induced ocular dyskinesia in Parkinson’s disease 2007;14: Davis, et al. © 2017 American Academy of Neurology

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