Functional positional eye and eyelid movements
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Functional positional eye and eyelid movements Mohamed Mabrouk Mustafa1,2 · Harry Akram3 · Manuel Oliva‑Domínguez4 · Diego Kaski5,3 Received: 16 June 2020 / Revised: 9 July 2020 / Accepted: 10 July 2020 © The Author(s) 2020
Abstract Background Positional manoeuvres are an important part of the neurological examination, particularly in patients with vertigo where the presence and characteristics of provoked nystagmus can help differentiate central from peripheral neurological disorders. Methods Case series of functional positional eye and eyelid movements. Results We report four patients with functional eye and eyelid movements provoked during positional manoeuvres. The range of abnormalities observed included positional convergence spasm, brief functional saccadic oscillations, and excessive positional blinking mimicking upbeat nystagmus. The functional movements described were present on a background of pre-existing peripheral or central nystagmus, or positional vertigo. Conclusion Functional positional eye and eyelid movements may co-exist with organic nystagmus that renders an accurate interpretation of the manoeuvre more challenging. A thorough understanding of the clinical features that differentiate these two categories of eye/eyelid movements makes the analysis easier, thus preventing misdiagnosis and avoiding unnecessary investigations. Keywords Functional · Eye movements · Positional · Eyelid · Psychogenic · Conversion disorder
Introduction Positional manoeuvres are an integral component of the neurological assessment of a patient with vertigo, where the presence of positional nystagmus can help differentiate between peripheral [such as benign paroxysmal positional vertigo (BPPV)] and central (such as cerebellar stroke) Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-020-10071-7) contains supplementary material, which is available to authorized users. * Diego Kaski [email protected] 1
Department of Neuroscience, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
2
Pharmacology Department, Faculty of Medicine and Health Science, Omdurman Islamic University, Omdurman, Sudan
3
Department of Neuro‑Otology, Royal National Ear Nose and Throat Hospital, University College London Hospitals, Huntley Street, London, UK
4
ENT Department, Hospital Costa del Sol, Marbella, Spain
5
Department of Clinical and Motor Neurosciences, University College London, 33 Queen Square, London, UK
vestibular disorders. Functional eye and eyelid movements have been observed in patients undergoing visual and ophthalmological assessments [1] but during a positional manoeuvre the eye movement that is being assessed is commonly brief and its interpretation complex (eye movements may be disconjugate, or nystagmus may beat in multiple planes). Misinterpretation of positional eye movements can thus lead to incorrect diagnosis and unnecessary or inappropriate investigations [2]. It becomes therefore of particular
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