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Journal of Child Neurology
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Paroxysmal Tonic Upgaze Presenting as a Clinical Isolated Syndrome

Nesrin Senbil, MD

Department of Child Neurology, Dr Sami Ulus Children's Hospital, Ankara Turkey, senbilon{at}yahoo.com

Deniz Yilmaz, MD

Department of Child Neurology, Dr Sami Ulus Children's Hospital, Ankara Turkey

Deniz Yüksel, MD

Department of Child Neurology, Dr Sami Ulus Children's Hospital, Ankara Turkey

Yavuz Gürer, MD

Department of Child Neurology, Dr Sami Ulus Children's Hospital, Ankara Turkey

We report a 3.5-year-old boy with sudden onset of episodic upward deviation of the eyes that led to diagnosis of paroxysmal tonic upgaze. Cranial magnetic resonance imaging showed right-hand side dominant bilateral hyperintense lesions in the mesencephalon and the thalamus on T2-weighted images. These lesions suggested a demyelinating pathology. Corticosteroid treatment was started. The episodes of upward eye deviation and the lesions on magnetic resonance imaging completely resolved after 3 days and 3 months, respectively. After 2 years of follow-up, he was symptom-free. Our patient with an isolated brain stem syndrome and no mental status changes was diagnosed as having a clinical isolated syndrome.

Key Words: paroxysmal tonic upgaze • clinical isolated syndrome • acute disseminated encephalomyelitis

This version was published on May 1, 2009

Journal of Child Neurology, Vol. 24, No. 5, 600-602 (2009)
DOI: 10.1177/0883073808327836
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