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| paroxysmal_tonic_gaze_infants [2026/09/20 10:59] – created Scott Larson | paroxysmal_tonic_gaze_infants [2026/09/20 11:13] (current) – Scott Larson | ||
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| - | ====== | + | ====== Paroxysmal |
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| + | see also: [[tonic_downgaze_children|Paroxymsal Tonic DownGaze]] | ||
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| + | Below is the response formatted in DokuWiki syntax. Since source URLs were not provided in the retrieved citations, the link targets are left as placeholders for insertion. | ||
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| + | ==== Benign | ||
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| + | * Benign (paroxysmal) tonic upgaze and paroxysmal tonic downgaze of infancy are two distinct entities | ||
| + | * Defined by opposite directions of vertical eye deviation and by different clinical courses, associations, | ||
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| + | === Benign (paroxysmal) tonic upgaze | ||
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| + | * Characterized by episodes of **sustained conjugate upward deviation of the eyes**, with compensatory neck flexion (chin-down posture) and **incomplete/ | ||
| + | * Onset is typically within the first year (mean age of onset ~5–6 months, though reported from the first week to age 7). | ||
| + | * Features include **diurnal fluctuation, | ||
| + | * Historically considered benign with eventual resolution, but the label is misleading: substantial proportions have **developmental delay, cognitive dysfunction, | ||
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| + | === Paroxysmal tonic downgaze of infancy === | ||
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| + | * Characterized by **tonic downward deviation of the eyes** (often slightly exotropic), with intermittent upward saccades — the mirror image of PTU. Also described as " | ||
| + | * An idiopathic/ | ||
| + | * However, symptomatic tonic downgaze is strongly associated with **CNS injury** — particularly periventricular leukomalacia and hypoxic-ischemic injury in preterm infants, correlating with subcortical visual loss, spastic diplegia/ | ||
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| + | === Key distinctions === | ||
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| + | ^ Feature ^ Benign tonic upgaze (PTU) ^ Tonic downgaze of infancy ^ | ||
| + | | Eye deviation | Sustained upward, with chin-down neck flexion | Sustained downward, often exotropic/ | ||
| + | | Saccade correction | Down-beating saccades on attempted downgaze | Intermittent upward saccades | | ||
| + | | Typical onset | First year, mean ~5–6 mo | Very early (days–12 wk) in benign form | | ||
| + | | Prognosis/ | ||
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| + | Both are on the differential of nonepileptic paroxysmal eye-movement phenomena of infancy and can be [[detecting_seizures_during_pediatric_eye_exam|mistaken for seizures]], so video documentation and normal EEG during events are useful in distinguishing them from epilepsy. | ||
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| + | ===== References ===== | ||
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| + | - [[https:// | ||
| + | - [[https:// | ||
| + | - [[https:// | ||
| + | - [[https:// | ||
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| + | - [[https:// | ||
| - | FIXME | ||