7-Year-Old Boy with Episodic Eye Widening and Lateral Gaze Deviation

Case at a Glance

A 7-year-old boy presented with episodes of sudden bilateral eye widening followed by conjugate lateral gaze deviation, sometimes accompanied by head turning. The episodes occur when the child is at rest or concentrating, and he appears unaware of the movements.

Patient's Story

The parents brought their 7-year-old son to the emergency department due to concerning eye movements that had recently begun. They described episodes where the child would suddenly open his eyes wide, followed by both eyes moving fully to one side, occasionally with associated head turning. These episodes occurred unpredictably when the child was sitting quietly or focusing on activities. When questioned about the movements, the child appeared unaware that they were occurring.

Initial Assessment

Physical examination was performed in the emergency department. The child appeared alert and interactive between episodes. Initial blood work was ordered to rule out metabolic causes. The attending physician recommended limiting screen time as a precautionary measure while awaiting test results.

The Diagnostic Journey

Given the paroxysmal nature of the eye movements and the child's lack of awareness, differential diagnosis included tic disorders versus seizure activity. The sudden onset, bilateral nature, and associated gaze deviation raised concern for possible seizure activity. Blood tests were pending to evaluate for metabolic abnormalities that could contribute to neurological symptoms.

Final Diagnosis

Pending further evaluation and test results. Differential diagnosis includes complex motor tics versus focal seizures with eye deviation.

Treatment Plan

Conservative management initiated with screen time restriction. Plan for pediatric neurology consultation and follow-up. Parents advised to document episodes with video recording for further clinical correlation. Await blood work results and consider EEG if episodes persist or worsen.

Outcome and Follow-up

Patient discharged home with close follow-up arranged. Parents counseled on seizure precautions and instructed to return if episodes increase in frequency or duration. Pediatric neurology referral to be expedited for comprehensive neurological evaluation and potential EEG monitoring.