Monday, November 5, 2007


This case idea was taken from a talk by Dr. Yvonne Wu for the pediatrics subspecialties elective.

You see a 20 month old toddler, brought in because of stumbling. The child was able to walk fine several days ago, but now looks uncoordinated with rhythmic jerking of the limbs. When you examine the child, you notice his eyes have rapid, dancing movements. They are spontaneous, arrhythmic conjugate saccades in all directions.

Challenge: Unfortunately, this is a paraneoplastic syndrome associated with a tumor. What tumor are you worried about?


Alex said...

Opsoclonus-myoclonus.. from small cell

Craig said...


This is opsoclonus-myoclonus-ataxia (OMA) which occurs in 1-3% of cases of neuroblastoma (but 50% children with OMA have neuroblastoma). This is an autoimmune disease; serum autoantibodies are present and immunosuppressive therapy improves the condition. It is sometimes called Dancing-Eyes Dancing-Feet Syndrome. A full oncologic evaluation should be undertaken. Elevated urinary VMA and HVA are diagnostic of neuroblastoma. A neuroblastoma is a cancer of the sympathetic nervous system and is seen in children.

Sources: UpToDate, Wikipedia.


Good job on opsoclonus-myoclonus, but when I google that, I find neuroblastoma > small cell.