A7-month-old girl was referred by her GP with a 6-hour history of ‘jittery eyes’. During the preceding day she had been ‘grizzly’ and non-specifically unwell. Her mother reported that on the day of admission she had had rigors and abnormal eye movements. The child had no significant past medical history. There was a family history of epilepsy. Paediatric review noted a miserable child with an inflamed right tympanic membrane and sudden eye movements up and to the right. An electroencephalogram was performed which was normal and a provisional diagnosis was made of right-sided otitis media with associated nystagmus resulting from putative labyrinthine involvement. The child was started on a course of amoxycillin and admitted. After 24 hours her condition had improved and she was discharged, pending an ophthalmology review 4 days later. At the ophthalmology review it was noted that although the child appeared generally well, she was distressed by recurrent sudden conjugate dextro-elevatory eye movements associated with simultaneous backward jerks of the head. She was ataxic but the examination was otherwise normal. The opinion of a paediatric ophthalmologist was sought, the diagnosis of opsoclonus was made and further investigation arranged. Chest radiography revealed bilateral paravertebral mass in the lower thoracic region (Figure 1). Magnetic resonance imaging confirmed this and showed anterior extension encircling the aorta and displacing the inferior vena cava (Figure 2). Considerable enhancement with gadolinium was noted. No involvement of liver, spleen or cranium was seen. A bone scan and marrow trephine was normal. An MIBG (metaiodobenzyl guanidine) scan showed increased uptake in the lower thoracic right paraspinal area. Tumour biopsy revealed rosettes of small round cells consistent with neuroblastoma. The diagnosis was therefore of thoraco-abdominal neuroblastoma stage 3. This was not resectable and chemotherapy was started as per the European Infant Neuroblastoma Protocol. She made rapid improvement with radiographic reduction in tumour size and dramatic improvement in her neurological features.