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A 21-year-old woman developed abdominal pain and nausea 1 day after laparoscopic appendectomy. She had received intravenous metoclopramide 10 mg and oral paracetamol 1000 mg at 07:00 hours and 15:00 hours. At 21:30 hours, she developed recurrent abnormal eye movements. She was anxious and had difficulty maintaining visual fixation, difficulty looking down or flexing her neck, and painless involuntary eye movements without diplopia. There had been only one previous similar episode, that same day at 15:00 hours, lasting about 10 minutes.
On examination 20 minutes after symptom onset, she was fully conscious and cooperative. She had equal and reactive pupils. There was repetitive involuntary conjugate upward and lateral right gaze deviation associated with neck extension and increased blink frequency (online supplemental video 1)(figure 1). She could return her gaze to the primary position for a few seconds, perform ocular movements without misalignments or restrictions, and could briefly flex her neck by forcing it with her hand. There were no other focal neurological signs. …
Contributors DSO participated in patient care, investigation, visualisation and writing-original draft. HPG participated in patient care, supervision and writing-review & editing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned. Externally peer reviewed by Ed Newman, Glasgow, UK.
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