A 55-year-old man was found unresponsive at home. He is an alcoholic cirrhosis patient. Examination He was hemodynamically stable but obtunded and minimally responsive to noxious stimuli. There was spontaneous, slow, horizontal, conjugate eye deviation, alternating every 2 to 4 seconds from one extreme to the other. However, these eye movements were smooth and continuous without interruption. Pupillary reactivity was maintained.
MRI revealed chronic microangiopathic changes, with no electroencephalographic correlate. Elevated plasma ammonia levels were noticed (359µmol/L), Normal range: 12 to 48 µmol/L). Determine this neuro-ophthalmic condition in this patient. *This case is from Docplexus editorial team for educative purpose only. Source: NEJM Stay Connected, the answer will be posted in the next 48h!
