Oculomasticatory_Myorhythmia

This case, previously reported in 1986, is published courtesy of John Selhorst, M.D., Saint Louis University School of Medicine, St. Louis, MO. (4) The patient is a 46 year old man who, over a period of six months, lost the ability to read and complained of excessive somnolence, occasional urinary incontinence, and recent 6-kg weight loss. A disabling, seronegative, non-deforming migratory arthritis had developed three years earlier. Gastrointestinal symptoms and fever had not occurred. Family History: Negative for neurological or arthritic disease. Neuro-ophthalmological examination: Visual acuity 20/50 right eye, 20/100 left eye Mild exposure keratitis, No uveitis by biomicroscopy Normal pupil reflexes Normal fundus exam Eye movements: 1.Mild bilateral ptosis 2.1 Hz smooth rhythmic convergence and divergence oscillations in primary gaze 3.Slow hypometric horizontal volitional saccades slightly restricted. 4.Rotation-induced horizontal eye movements full, compensatory saccades absent. 5.Supranuclear paralysis of vertical gaze 6.Voluntary vergence movements were disrupted by the continuous oscillations. Additional signs: Rhythmic elevation and depression movements of the mandible due to concurrent contractions of the masticatory muscles. The rhythmic jaw movements were synchronous with the ocular oscillations. Both the eye and jaw movements were continuous during the day, persistent in sleep, and unaltered by environmental stimuli. Palatal myoclonus was never observed. Hematological Studies: Sedimentation rate 87 mm/per hour Circulating immune complexes Raji cell, C1-Q binding markedly elevated. Serum immunoelectrophoresis mildly increased IgA and IgG, no monoclonal peaks Lumbar Puncture: Cerebrospinal fluid 1 WBC, Protein 41mg/dl, Glucose 49 mg/dl, IgG/albumin ratio 0.40 (normal