Good morning,
I have a patient who had large pontine hemorrhage and most recent MRI report describes: "Previous pontine hemorrhage with evolving encephalomalacia. There is
associated Wallerian degeneration in the middle cerebellar peduncles as well as
left-sided hypertrophic olivary degeneration. "
Scan done at outside facility and I have not seen it.
He has vertical eye movement abnormalities that look like something between downbeat nystagmus and oculopalatal tremor - large vertical movements that look a bit faster going down but also look mostly pendular and are slower than typical nystagmus. He does not have any palatal movements. He is on a lot of meds for uncontrolled hypertension and depression - likely to have issues with drug interactions.
If we assume this is more oculopalatal tremor than downbeat nystagmus - anyone have any success with meds to improve the movements? He is having significant oscillopsia and he has already failed clonazepam due to side effects.
Thanks,
ELB
Eric L. Berman, MD
Dr. William A. and Sandra F. Johnson Endowed Chair in Neuro-Ophthalmology
Director, Neuro-Ophthalmology Service
Storm Eye Institute
Medical University of South Carolina