![]() Usually, within a few weeks or months, the symptoms resolved. CSF protein and cell count were often elevated. Patients developed ocular flutter or opsoclonus and shivering movements of the head and body with preserved consciousness following a prodrome of malaise and mild fever. He was able to walk without support and was discharged with tapering dose of oral steroids.Ī syndrome of benign encephalitis with ocular oscillation and truncal ataxia was described in the 1960's by Smith and Walsh and later Cogan. The patient had symptomatic improvement in the form that his ataxia improved and ocular flutter decreased. He was given 5 days course of intravenous methylprednisolone after fever subsided. His fever subsided, but ocular flutter and ataxia persisted. He was treated with antipyretics and intravenous fluids. Cerebrospinal fluid (CSF) analysis was normal. Magnetic resonance imaging brain plain was normal. Serum dengue nonstructural 1 antigen and immunoglobulin M antibodies were positive. ![]() Liver function test showed transaminitis (aspartate aminotransferase: 110 IU/L alanine aminotransferase: 156 IU/L). Complete hemogram showed low platelet count (0.76 lakh). Other system examination showed mild hepatosplenomegaly. He had titubation with truncal, stance, and gait ataxia. Motor examination showed normal tone and muscle power with sluggish deep tendon reflexes. Oculomotor abnormality in the form of sudden conjugate horizontal saccadic oscillations without intersaccadic interval (ocular flutter) occurring spontaneously, with eyes open and closed, during pursuit and saccades, and mainly in horizontal than vertical direction of gaze was seen. There was blurring of vision but no dysphagia, dysarthria, weakness or incoordination of limbs, sensory symptoms, or myoclonic jerks. On the 3 rd day of fever, he noticed giddiness associated with difficulty in sitting and standing needing support of family members and swaying while walking. He also had dull aching continuous holocranial headache associated with 3–4 episodes of vomiting. A 14-year-old male child presented with fever associated with chills of 3 days duration. ![]()
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