Abstract
Zika virus (ZIKV) is an emerging flavivirus which has been linked to a number of neurologic manifestations such as Guillain-Barré syndrome (GBS), transverse myelitis, and meningo-encephalitis. Ophthalmologic manifestations are increasingly being reported; however, ocular dyskinesias have not been described in this context to date. Herein, we report a case of a 22-year-old female who presented with ocular flutter and associated Guillain-Barré syndrome following acute ZIKV infection. We speculate that although such symptoms may have originated from a direct viral insult, a post-infectious autoimmune mechanism may not be excluded. Physicians should include ZIKV as well as other flaviviruses in their diagnostic workup for all patients with ocular flutter/opsoclonus, after excluding other non-infectious causes of central nervous system pathology. To the best of our knowledge, this is the first report on the association of ocular flutter, GBS, and ZIKV infection.
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References
Araujo AQC, Silva MTT, Araujo APQC (2016) Zika virus-associated neurological disorder: a review. Brain 139(8):2122–2130
Bergenius J (1986) Saccade abnormalities in patients with ocular flutter. Acta Otolaryngol 102(3–4):228–233
Cao-Lormeau VM, Blake A, Mons S, Lastère S, Roche C et al (2016) Guillain-Barré Syndrome outbreak associated with Zika virus infection in French Polynesia: a case-control study. Lancet 387(10027):1531–1539
Case Definitions [PAHO web site]. April 1st, 2016. Available at: http://www.paho.org/hq/index.php?option=com_content&view=article&id=11117&Itemid=41532&lang=en Accessed May 31, 2017
Furman JM, Eidelman BH, Fromm GH (1988) Spontaneous remission of paraneoplastic ocular flutter and saccadic intrusions. Neurology 38(3):499–501
Guidance for U.S. Laboratories Testing for Zika Virus Infection [CDC web site]. May 5, 2017. Available at: https://www.cdc.gov/zika/laboratories/lab-guidance.html. Accessed May 31, 2017
Hankey GJ, Sadka M (1987) Ocular flutter, postural body tremulousness and CSF pleocytosis: a rare post-infectious syndrome. J Neurol Neurosurg Psychiatry 50(9):1235–1236
Hébert J, Armstrong D, Daneman N et al (2017) Adult-onset opsoclonus-myoclonus syndrome due to West Nile Virus treated with intravenous immunoglobulin. J Neuro-Oncol 23(1):158–159. https://doi.org/10.1007/s13365-016-0470-3
Leigh LJ, Zee DS (1999) The Neurology of Eye Movements. 3rd ed. New York, NY: Oxford University Press:133–144, 449–456
Mahale RR, Mehta A, Shankar A, Buddaraju K, Srinivasa R (2016) A surprising cause of isolated oculomotor nerve palsy with pupillomotor palsy. Ann Indian Acad Neurol 19(1):159–160. https://doi.org/10.4103/0972–2327.173300
Nakayasu K, Sakimoto T, Minami M, Shigihara S, Ishikawa H (2010) Case of Fisher syndrome with ocular flutter. Nippon Ganka Gakkai Zasshi 114(6):539–542
Pieret F, Sindic CJ, Chalon MP et al (1996) The anti-Hu syndrome: a clinical and immunological study of 7 cases. Acta Neurol Belg 96(2):108–116
Ramat S, Leigh RJ, Zee DS et al (2005) Ocular oscillations generated by coupling of brainstem excitatory and inhibitory saccadic burst neurons. Exp Brain Res 160(1):89–106
Slenczka W (2016) Zika Virus Disease Microbiol Spectr:4(3)
Ventura CV, Maia M, Travassos SB, Martins TT, Patriota F, Nunes ME, Agra C, Torres VL, van der Linden V, Ramos RC, Rocha MÂ, Silva PS, Ventura LO, Belfort R Jr (2016) Risk factors associated with the ophthalmoscopic findings identified in infants with presumed Zika virus congenital infection. JAMA Ophthalmol 134(8):912–918. https://doi.org/10.1001/jamaophthalmol.2016.1784
Wiest G, Safoschnik G, Schnaberth G, Mueller C (1997) Ocular flutter and truncal ataxia may be associated with enterovirus infection. J Neurol 244(5):288–292
Wong A (2007) An update on opsoclonus. Curr Opin Neurol 20(1):25–31
Zaro-Weber O, Galldiks N, Dohmen C, Fink GR, Nowak DA (2008) Ocular flutter, generalized myoclonus, and trunk ataxia associated with anti-GQ1b antibodies. Arch Neurol 65(5):659–661
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The authors thank Dr. Jose Felix Oletta for his valuable advice.
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Karam, E., Giraldo, J., Rodriguez, F. et al. Ocular flutter following Zika virus infection. J. Neurovirol. 23, 932–934 (2017). https://doi.org/10.1007/s13365-017-0585-1
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DOI: https://doi.org/10.1007/s13365-017-0585-1