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Atlas of Neurology—A Case-based Approach
by Satish V Khadilkar, Kalyan B BhattacharyyaThis young lady gives the history of sudden involuntary deviation of the eyes to the left while she is working or talking to somebody. Her consciousness is retained. The video shows at least two such brief episodes where along with tonic deviation of the eyes to the left, transient blinking and closure of the eyelids is seen and there is simultaneous speech arrest. She is not amnestic of the attacks and there is no other sign anywhere. There is minimal esotropia in the left eye. What are the possibilities? Tonic transient deviation of the eyes to one side usually indicates an irritative lesion in the contralateral frontal eye field. Simultaneous speech arrest can suggest a focal seizure, where the discharge spread to involve the speech area in the pre-central gyrus. Blepharospam is an alternate diagnosis but there the unusual picture is more prolonged contraction of the eyelids and an infructuous attempt to open it. Electrophysiological and imaging studies were non-contributory.
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