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A 68-year-old male with 45-pack-year smoking history presented with oscillopsia, progressive clumsiness, gait ataxia, and vertigo for 2 months. Examination revealed truncal ataxia, opsoclonus, and ocular flutter (video). Opsoclonus and ocular flutter are similar findings. While opsoclonus refers to involuntary multi-directional saccades, ocular flutter is characterized by a burst of horizontal saccades without an intersaccadic interval. Neuroimaging and serum paraneoplastic antibody testing including ANNA-2/anti-Ri were normal. CT chest demonstrated pulmonary nodules and diffuse lymphadenopathy. Lymph node biopsy showed metastatic, poorly differentiated carcinoma. Opsoclonus-myoclonus-ataxia is commonly associated with paraneoplastic antibodies arising from breast or lung cancers, though antibodies are not discovered in all cases.^1,2 Evaluation for occult neoplasia should be pursued.

Video legend: Involuntary burst of horizontal saccades without an intersaccadic interval typical of ocular flutter was the predominant pattern identified during telehealth evaluation.

References:

1. Klaas JP, Ahlskog JE, Pittock SJ, et al. Adult-onset opsoclonus-myoclonus syndrome. Arch Neurol. 2012;69(12):1598-1607; doi:10.1001/archneurol.2012.1173
2. Popławska-Domaszewicz K, Florczak-Wyspiańska J, Kozubski W, Michalak S. Paraneoplastic movement disorders. Rev Neurosci. 2018;29(7):745-755; doi:10.1515/revneuro-2017-0081

Submitted by: Sarah S. Zaheer, MD, Prisma Health-Upstate, University of South Carolina School of Medicine, Sanjeev Sivakumar, MD, Prisma Health-Upstate, University of South Carolina School of Medicine

Dr. Zaheer reports no disclosures. Dr. Sivakumar reports: Stock/Stock Options, Medical Equipment & Materials: Abbot labs,1 year; Eli Lilly and company, 1 year; Teladoc health, 1.5 years.