This patient has oculomotor apraxia (OMA). In spasmus nutans, the head movement is a vertical nodding, and a fine asymmetric nystagmus is usually present. This patient does not have ptosis or eyelid movements that are consistent with Marcus Gunn jaw-winking syndrome. A tic disorder would have involuntary movements that are generally shorter and more spasmic in duration. Hemifacial spasm consists of involuntary contractions on one side of the face.
An MRI of the brain and orbits was obtained. MRI showed hypoplasia of the olfactory bulbs with all other cranial nerves intact. It also showed a dysmorphic and bulky-appearing cerebellum with a small superior and larger inferior vermis and a slightly prominent fourth ventricle with no molar tooth sign or Chiari malformation.
The remainder of neuroimaging study findings was within normal limits.
The patient continues to be followed in the eye clinic and will also see neurology for evaluation.
Medscape Ophthalmology © 2015
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Cite this: Jessica L. Hauser, Kimberly G. Yen. The Child With Abnormal Head Movements - Medscape - Oct 27, 2015.