EpistemisEcular dysmetria
Specialty: Neurology.
Why it occurs
- Lesions of the afferent or efferent cerebellar pathways (cerebellar stroke, multiple sclerosis)
- Tumors of the cerebellar vermis (medulloblastoma, astrocytoma)
- Wilson's disease (hepatolenticular degeneration)
- Hereditary spinocerebellar ataxias
- Toxicity due to anticonvulsant drugs in high doses (phenytoin, carbamazepine)
Initial workup
Exploration of saccadic movements by asking the patient to change their gaze quickly between two fixed targets, observing whether the gaze goes over the target (hypermetry) or falls short (hypometry) requiring correction saccades; Brain MRI focused on the posterior fossa and cerebellum; dosage of serum levels of antiepileptic drugs.
red flags
New onset acute ocular dysmetria associated with severe gait ataxia, persistent suboccipital headache, repetitive vomiting and lethargy, indicative of an expansive process or cerebellar hemorrhage with risk of herniation.
Standard management
- Adjustment or reduction of anticonvulsant doses if toxicity is noted
- Treatment of the underlying pathology (corticosteroids in flares of multiple sclerosis, copper chelators in Wilson's disease).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 2