VCOM Research Day Program Book 2023

Medical Resident Research Case Reports

32 Bilateral Horizontal And Vertical Nystagmus in a Patient with History of Seizure Disorder Resulting from Electrocution Incident

James G. Lo, PGY 1; Ravi Sinha, PGY 1; Michalla Braford, PGY 1; Kristin Syed, PGY 1; Lou-Anne Acevedo-Moreno, PGY 1; Oluwaseun Somorin.

HCA Healthcare LewisGale Medical Center, Salem

Nystagmus is a rapid, rhythmic, involuntary eye movement. It can range from physiological variant to pathological findings 1 . Anatomical structures to be considered are cortices, anterior visual tracts, brainstem, cerebellum and peripheral vestibular apparatus. Vertical nystagmus, one of the almost always pathological nystagmus types, may be of posterior fossa lesions, medication side effects, vitamin deficiencies, inflammatory, autoimmune, paraneoplastic, hereditary and degenerative etiologies. Vertical nystagmus may also be provoked when patient was directed to make vertical gazes, as seen in this patient. A 25-year-old hemodynamically stable Caucasian male with past medical history of seizure disorder secondary to electrocution presented to hospital with

dizziness associated with nystagmus and vertigo. Physical exams reveal bilateral horizontal and vertigo. Romberg, dysmetria, dysdiadokokinesia, gait abnormalities, and compromised memory present. Dix-Hallpike negative. CSF non-xanthochromic with no pleocytosis. CT and MRI brain normal. ENT consulted with negative findings. Per Neurology, no EEG needed at the time as patient was suspected to have viral vs autoimmune cerebellitis. Symptoms resolved after five days of IV Solu-Medrol, and patient was discharged to follow up with his PCP, outpatient ENT and neurology. Studies show that electrocution may result in multiple cranial palsies 2 . Signs of multiple cranial palsies may vary in degrees of nerve damages, but usually evident with imaging findings with cavernous sinus, clivus/base of skull lesion and subarachnoid space involvement. However,

herein we present a case where a person electrocuted four years ago showing multi-directional nystagmus with no other signs of cranial nerve palsies or aforementioned imaging findings. 1 Sekhon, Rupinder K., Franklyn Rocha Cabrero, and Jonathon P. Deibel. "Nystagmus Types." StatPearls [Internet]. StatPearls Publishing, 2021. 2 Soni, Rahul, Abhinav Kumar, and Kuldeep Kumar Ashta. "A Case of Multiple Cranial Nerves Palsy Post Electrocution." (2021).

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