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Gaethje 2 eye pokes, both eyes + Groin kick = ZERO CALLS WTF ?

190,141 次观看 • 6 个月前 •via X (Twitter)

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Can serotonin syndrome trigger dancing eyes? Apparently the answer is (rarely) YES. Do you know the 5 'Aspen' tips to differentiate the opsoclonus myoclonus syndrome from other causes ? We frequently think of the syndrome in association w/ autoimmune and also paraneoplastic (causes), however we need to think bigger. A nice reminder provided by Fernanda Lustosa Cabral Gomez and colleagues in Movement Disorders Clinical Practice. Key Points: - Serotonin syndrome: cause is excessive serotonergic activity in the central and peripheral nervous system. - The cause is usually medication use or drug interactions. - The authors show a case w/ serotonin syndrome. - He was on fluoxetine, lithium, amitriptyline, and clonazepam. - Bupropion was then added. - Clues to the underlying diagnosis in this case were "flushing, diaphoresis, tachycardia, tachypnea, opsoclonus, spontaneous myoclonic jerks, and stimulus sensitive myoclonus." - How did they treat it? Stop psychotropic medications and added diazepam. Resolved in a few days. My take: Here are my top 5 'Aspen' tips to differentiate 'dancing eyes' from other syndromes: 1 - Examine the eye movements and remember the eye movements in opsoclonus: Multidirectional → Horizontal + Vertical + Torsional + Oblique; there is no intersaccadic interval (continuous bursts) 2 - Conjugate (no dissociation between the eyes) 3- Eye movements are triggered or worsened by fixation and voluntary gaze holding 4 - Associated neurological signs: myoclonus, cerebellar signs, encephalopathy (paraneoplastic, parainfectious, autoimmune) 5 - Flutter is flat (horizontal); opsoclonus is omnidirectional and ongoing. More tips: Opsoclonus-myoclonus syndrome: look for all the potentially associated features including: myoclonus, opsoclonus, and occasionally ataxia, encephalopathy, and tremor. The eyes are the key: look for saccadic intrusion characterized w/ uninterrupted bursts of conjugate eye movements. The authors remind us to think about the eye movements as "chaotic, arrhythmic, and multidirectional." In young kids think neuroblastoma. In adults think paraneoplastic (automimmune), parainfectious, or idiopathic. Cancers are present in 60% of adults. The authors remind us that "toxins and drugs are rare causes." They also remind us not to forget about "cocaine, amitriptyline, phenytoin, venlafaxine, cefepime, scorpion venom, organophosphates, lithium toxicity and their case that was serotonin syndrome." So when you see dancing eyes, here is the plan: veni, vidi, vici – I came, I saw, I conquered. Parkinson's Foundation Norman Fixel Institute for Neurological Diseases #Parkinson Movement Disorders Clinical Practice

Michael Okun

17,515 次观看 • 1 年前