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EN
Introduction. Myoclonic epilepsy with ragged red fibers (MERRF) is a rare, progressive mitochondrial disease affecting multiple systems, including the central nervous system. Typical MERRF symptoms include: myoclonus, epileptic seizures, ataxia and cognitive decline. In mitochondrial diseases selective cognitive impairment or generalized decline, called mitochondrial dementia, is usually diagnosed. Description of case. We present the case of an 18-year-old patient with progressive neurological symptoms such as multifocal myoclonus, cerebellar syndrome (gait impairment, intention tremor, ataxia and dysmetria). The diagnosis of MERRF was confirmed at the age of 16. Neuropsychological examination showed slowing of verbal learning and deficient spontaneous recall with improvement on recognition as well as low verbal fluency. Discussion. The authors discuss differential diagnosis of mitochondrial diseases (MIDs) in respect to cognitive function impairment and, in particular, to dementia: MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes), KSS (Kearns-Sayre syndrome), NARP syndrome (neuropathy, ataxia, and retinitis pigmentosa and ptosis). The authors emphasize importance of comprehensive neuropsychological assessment in differential diagnosis of MIDs. Conclusion. Mild and selective cognitive impairment was identified. The type and degree of cognitive function impairment is not sufficient to diagnose dementia in this particular case of MERRF. Comprehensive neuropsychological assessment is crucial in MID in order to provide the patient with useful recommendations for education planning.
EN
Voluntary nystagmus is a pendular, rapid, primarily horizontal oscillation of the eyes, without a slow phase, often initiated and maintained by voluntary effort, its duration limited by fatigue. We present a case of 13-year old girl with nystagmus, severe headache and nausea. On examination the subject’s eyes moved normally, but during fixation at near point horizontal nystagmus was observed and the girl complained about blurred vision. Otherwise, opthalmological examination and brain MRI revealed no abnormalities. Close observation of the girl proved that she can produce nystagmus voluntarily. Voluntary nystagmus should be considered in every individual case of patients diagnosed with isolated, intermittent nystagmus, especially of those without ophthalmologically or neurologically pathologic findings.
PL
Oczopląs umyślny (ang. voluntary nystagmus) to wahadłowe, szybkie, poziome oscylacje gałek ocznych, bez fazy wolnej, inicjowane i utrzymywane przez pacjenta świadomie. Czas trwania tych oscylacji jest ograniczony zmęczeniem pacjenta. Przedstawiamy przypadek 13-letniejdziewczynki z oczopląsem, silnym bólem głowy i nudnościami. Podczas badania neurologicznego, w trakcie fiksacji stwierdzono oczopląs poziomy, dziewczyna skarżyła się również na zaburzenia widzenia pod postacią zamazanego obrazu. W badaniach dodatkowych (badanie okulistyczne, rezonans magnetyczny mózgowia) nie stwierdzono nieprawidłowości. Dokładna obserwacja pacjentki udowodniła, że dziewczynka świadomie demonstruje oczopląs. Umyślny oczopląs należy rozważyć w każdym przypadku, w którym zdiagnozowano przerywany, izolowany oczopląs, szczególnie w sytuacji gdy nie stwierdzono zmian okulistycznych lub innych objawów neurologicznych.
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