April 21, 2020 e-Pearl of the Week: Oculogyric crisis (OC)

Oculogyric crisis (OC)

Oculogyric crisis (OC) presents with intermittent or sustained conjugate tonic eye deviation (usually upward).1 OC can also be accompanied by neck flexion, jaw opening, blepharospasm, tongue protrusion, and autonomic signs such as perspiration, pupillary dilation, and increases in blood pressure and heart rate. Incidence is 6% of all ocular dystonias. Pathophysiology is hypothesized as a cholinergic- dopaminergic imbalance in the mesencephalic vertical gaze center. OC are commonly induced by medications (neuroleptics, metoclopramide).2 Other less common causes include infections (neurosyphilis, postencephalitic parkinsonism), and space-occupying lesions around the 3rd ventricle (cystic glioma). Differential diagnoses include versive seizures, ocular dyskinesia, and paroxysmal tonic upgaze. Treatment with parenteral benztropine or diphenhydramine may lead to immediate remission for medication-induced OC, and then, afterwards it is recommended to provide anticholinergics for a short duration (4–7 days). Refractory cases respond to benzodiazepines such as lorazepam/diazepam.3         

References

  1. Barow E, Schneider SA, Bhatia KP, Ganos C. Oculogyric crises: etiology, pathophysiology and therapeutic approaches. Parkinsonism Relat Disord 2017;36:3–9.
  2. Richa S, Yazbek JC. Ocular adverse effects of common psychotropic agents: a review. CNS Drugs 2010;24:501–526.
  3. Lee A. S. Treatment of drug-induced dystonic reactions. JACEP 1979;8:453–457.

Submitted by Tanay Satarkar, Medical Graduate, Bukovinian State Medical University (Chernivtsi, Ukraine) and Faisal Khan, MD, DABSM, DABPN, Consultant Neurologist, Sugar Land Neurology and Sleep (Sugar Land, Texas)

Tanay Satarkar and Dr. Khan report no disclosures.