Saccadic eye movements or...what?

[mycrofft]

Pt c/o dizzyness, weakness times three days. Gait, seat and stance unaffected. VS WNL, fingerstick glucometry WNL, and positional VS unchanged. No other c/o. No obvious signs of trauma, recall recent and distant past.

Pt has DX as psychotic and hypertensive, on Effexor, Clozaril, and Propanolol from psych services, and Atenolol from medical services for HTN. Latest Clozaril serum level was fine, as was chem panel and CBC.

Only objective finding: eye-following is "cogwheel", i.e., when you pass your finger right left up or down and the pt follows it with only the eyes, they follow in rythmic jerks and pauses throughout the entire sweep, not just the limits of travel. Pt doesn't hold eye contact so it's hard to evaluate when not being obviously "evaluated".

Thoughts?

 

[emtech419]

sounds neurological to me. any history of stroke? CAOx4? Can we trust the pt's memory of no trauma?

 

[piranah]

can be deleted ...srry

 

[piranah]

nystagmus, a jittery movement of the eye. unable to follow fluently. ETOH, drug involvement usually a CNS depressant. possibly a psych med reaction.

either horizontal/vertical nystagmus....or both

 

[BruceD]

Of course, not really enough to go on.

Several psych meds have extrapyramidal side effects, even at normal serum levels.

Not that it matters, but did you pursue what the patient meant by 'weakness' and what he meant by 'dizzyness'?

Weakness could be fatigue or musculoskeletal weakness.
dizzyness can be vertigo (illusion of motion, often goes with nystagmus), lightheadedness (is that even a word...), or may just feel unsteady when they walk.

Take care, stay safe
-B

 

[mycrofft]

I'm safe and the pt was a moron.

A handful of unknown pills, period.