Melanie Ryan-Graham, MD | Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA Simmons Lessell, MD | Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
Vision: 20/20 OD, 20/20 OS Pupils: Normal OU, No APD Color: Normal OU External: Normal OU Motility: Extraocular motility was abnormal . The patient had conjugate eye movements, and full ductions. There was a jerk nystagmus with the slow phase upgoing and the fast phase down-going. Fixation did not affect the nystagmus. The nystagmus was more prominent in down and lateral gaze, and dampened with up-gaze. Downward pursuit was abnormal. Slit lamp examination: Normal OU Fundus examination: Normal disc, macula, vessels OU Visual fields: Goldmann visual fields and Amsler grid testing were normal Neurologic Exam: The neurologic examination was notable for restricted range of motion of the neck, a diffuse increase in muscle tone, decreased proprioception of hands and feet bilaterally, dysmetria of the left arm, positive Romberg sign, ataxic gait, abnormal tandem gait, hyperreflexia with bilateral upgoing toes and ankle clonus.
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