Oculogyric crises entities

Clinic

• OGC is the name of a dystonic reaction to certain drugs or medical conditions characterized by a prolonged involuntary upward deviation of the eyes.
• It refers to the bilateral elevation of the visual gaze, but several other responses are associated with the crisis.
• Epilepsy can manifest as oculogyric seizures, also called versive seizures.

Signs and symptoms

• Initial symptoms include restlessness, agitation, malaise, or a fixed stare.
• Extreme and sustained upward deviation of the eyes. In addition, the eyes may converge, deviate upward and laterally, or deviate downward.
• The most frequently reported associated findings are backwards and lateral flexion of the neck, widely opened mouth, tongue protrusion, and ocular pain.
• However, the condition may also be associated with intensely painful jaw spasms which may result in the breaking of a tooth.
• A wave of exhaustion may follow an episode. The abrupt termination of the psychiatric symptoms at the conclusion of the crisis is most striking.
• Other features
  • Mutism,
  • Palilalia,
  • Eye blinking,
  • Lacrimation,
  • Pupil dilation,
  • Drooling,
  • Respiratory dyskinesia,
  • Increased blood pressure and heart rate,
  • Facial flushing, headache, vertigo, anxiety, agitation,
  • Compulsive thinking,
  • Paranoia,
  • Depression,
  • Recurrent fixed ideas,
  • Depersonalization,
  • Violence
  • Obscene language.

Causes

Drugs that can trigger an oculogyric crisis include

• Drugs such as haloperidol, chlorpromazine, fluphenazine, olanzapine, carbamazepine, chloroquine, cisplatin, diazoxide, levodopa, lithium, metoclopramide, lurasidone, domperidone, nifedipine, pemoline, phencyclidine ("PCP"), reserpine, and cetirizine, an antihistamine
• Other causes can include aromatic L-amino acid decarboxylase deficiency,
• Postencephalitic Parkinson's
• Tourette's syndrome
• MS
• Neurosyphilis,
• Head trauma, bilateral thalamic infarction, lesions of the fourth ventricle, cystic glioma of the third ventricle,
• Herpes encephalitis
• Kernicterus
• Juvenile Parkinson's disease.
• Patients with procyclidine addiction or craving may simulate signs of EPS to receive procyclidine.