The patient, a 4-month-old girl studied for psychomotor retardation, was referred to the motility section due to deficit in ocular fixation.
It was observed that, in order to change the direction of the gaze, the child was forced to make sudden lateral movements of the head with the eyes fixed on the new object.
The usual exploration was performed to find alterations that justified difficulty: ocular motility, BMC and F.O. were normal.
The neuro-ophthalmological examination continued: the optokinetic reflex was altered in its rapid phase (reduced or absent) in the horizontal plane.
The visual evoked potentials (P.E.V.) were normal.
Electroretinogram (ERG) was not performed due to the young age of the patient.
Neurological examination revealed hypertonia of the lower limbs with hyperreflexia.
Brain mapping detected neurological or systemic processes (EEG, MRI, amino acids in blood, urine and CSF, ammonia, pyruvic acid in blood and long CSF, normal TCH fatty acids.
Only lactic acid was found in blood and proteins in CSF slightly high, with no evidence of disease.
Human herpes virus type 6 (HHHV-6) was amplified by PCR, and no association with oculomotor apraxia has been described.
She was diagnosed with C.O.M.A. with signs of bilateral nonspecific pyramidal involvement.
