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Zachou A, Armenis G, Stamelos I, Stratigakou-Polychronaki E, Athanasopoulos F, Anagnostou E. Clinical utility of square-wave jerks in neurology and psychiatry. FRONTIERS IN OPHTHALMOLOGY 2024; 3:1302651. [PMID: 38983056 PMCID: PMC11182280 DOI: 10.3389/fopht.2023.1302651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/12/2023] [Indexed: 07/11/2024]
Abstract
Human eye fixation is steadily interrupted by small, physiological or abnormal, eye movements. Square-wave jerks (SWJ) are the most common saccadic intrusion which can be readily seen at the bedside and also quantified using oculographic techniques. Various neurological, neuropsychiatric and psychiatric disorders display abnormal fixational eye movement patterns characterized by frequent SWJ. For the clinician, SWJ are particularly important because they can be readily observed at the bedside. Here, we will discuss the pathological conditions that present with SWJ and explore the expanding body of literature suggesting that SWJ may serve as a potential indicator for various clinical conditions.
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Affiliation(s)
- Athena Zachou
- Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece
| | - Georgios Armenis
- Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece
| | - Ioannis Stamelos
- Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece
| | | | | | - Evangelos Anagnostou
- Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece
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Anagnostou E, Karavasilis E, Potiri I, Constantinides V, Efstathopoulos E, Kapaki E, Potagas C. A Cortical Substrate for Square-Wave Jerks in Progressive Supranuclear Palsy. J Clin Neurol 2020; 16:37-45. [PMID: 31942756 PMCID: PMC6974821 DOI: 10.3988/jcn.2020.16.1.37] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 01/18/2023] Open
Abstract
Background and Purpose Square-wave jerks (SWJs) are the most common saccadic intrusion in progressive supranuclear palsy (PSP), but their genesis is uncertain. We aimed to determine the characteristics of SWJs in PSP (the Richardson subtype) and Parkinson's disease (PD) and to map the brain structures responsible for abnormal SWJ parameters in PSP. Methods Eye movements in 12 patients with PSP, 12 patients with PD, and 12 age-matched healthy controls were recorded using an infrared corneal reflection device. The rate, mean amplitude, and velocity of SWJs were analyzed offline. Voxel-based morphometry using a 3-Tesla MRI scanner was performed to relate changes in brain volume to SWJ parameters. Results The SWJ rate was more than threefold higher in PSP patients than in both PD patients and controls (mean rates: 33.5, 10.3, and 4.3 SWJs per minute, respectively). The volumes of neither the midbrain nor other infratentorial brain regions were correlated with the SWJ rate. Instead, highly significant associations were found for atrophy in the superior, middle, and inferior temporal gyri in the PSP group. Conclusions SWJs in PSP are not mediated by midbrain atrophy. Instead, supratentorial cortical structures located mainly in the temporal lobe appear to be deeply involved in the generation of abnormally high SWJ rates in these patients. Known anatomical connections of the temporal lobe to the superior colliculus and the cerebellum might play a role in SWJ genesis.
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Affiliation(s)
- Evangelos Anagnostou
- Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Efstratios Karavasilis
- 2nd Department of Radiology, University General Hospital 'Attikon,' School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Irini Potiri
- Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Constantinides
- Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Efstathopoulos
- 2nd Department of Radiology, University General Hospital 'Attikon,' School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisavet Kapaki
- Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Potagas
- Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Puri I, Garg D, Srivastava AK, Singh L, Shukla G, Goyal V. Langerhans Cell Histiocytosis Presenting With Late-Onset Sporadic Ataxia. Mov Disord Clin Pract 2019; 6:716-718. [PMID: 31745485 DOI: 10.1002/mdc3.12830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Inder Puri
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Divyani Garg
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | | | - Lavleen Singh
- Department of Pathology All India Institute of Medical Sciences New Delhi India
| | - Garima Shukla
- Department of Neurology All India Institute of Medical Sciences New Delhi India
| | - Vinay Goyal
- Department of Neurology All India Institute of Medical Sciences New Delhi India
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Yeh EA, Greenberg J, Abla O, Longoni G, Diamond E, Hermiston M, Tran B, Rodriguez-Galindo C, Allen CE, McClain KL. Evaluation and treatment of Langerhans cell histiocytosis patients with central nervous system abnormalities: Current views and new vistas. Pediatr Blood Cancer 2018; 65. [PMID: 28944988 DOI: 10.1002/pbc.26784] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/10/2017] [Accepted: 07/26/2017] [Indexed: 12/12/2022]
Abstract
Central nervous system (CNS) involvement in Langerhans cell histiocytosis (LCH) can include mass lesions of the hypothalamic pituitary axis, choroid plexus, cerebrum, and cerebellum or magnetic resonance imaging (MRI) signal abnormalities of the cerebellum, pons, and basal ganglia. The term neurodegenerative (ND) CNS-LCH has been given to the MRI signal abnormalities and neurologic dysfunction, although initially patients may have no clinical symptoms. Standardized evaluations to better understand the natural history and response to therapy are needed. We propose guidelines for clinical, radiologic, and physiologic tests as a framework for developing the best methods of evaluation, which can then be tested in prospective treatment protocols.
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Affiliation(s)
- E Ann Yeh
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jay Greenberg
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, District of Columbia
| | - Oussama Abla
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giulia Longoni
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eli Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michelle Hermiston
- Department of Pediatric Oncology, UCSF Medical Center-Mission Bay, San Francisco, California
| | - Brandon Tran
- Department of Radiology, Baylor College of Medicine, Houston, Texas
| | | | - Carl E Allen
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers and Baylor College of Medicine, Houston, Texas
| | - Kenneth L McClain
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers and Baylor College of Medicine, Houston, Texas
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Zhu M, Yu BB, Zhai JL, Sun G. Case of Langerhans Cell Histiocytosis That Mimics Meningioma in CT and MRI. J Korean Neurosurg Soc 2016; 59:165-7. [PMID: 26962425 PMCID: PMC4783485 DOI: 10.3340/jkns.2016.59.2.165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 11/27/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is a rare disorder histologically characterized by the proliferation of Langerhans cells. Here we present the case of a 13-year-old girl with LCH wherein CT and MRI results led us to an initially incorrect diagnosis of meningioma. The diagnosis was corrected to LCH based on pathology findings. An intracranial mass was found mainly in the dura mater, with thickening of the surrounding dura. It appeared to be growing downward from the calvaria, pressing on underlying brain tissue, and had infiltrated the inner skull, causing a bone defect. The lesion was calcified with the typical dural tail sign. The dural origin of the lesion was verified upon surgical dissection. There are no previous reports in the literature describing LCH of dural origin presenting in young patients with typical dural tail signs and meningioma-like imaging findings. The current case report underscores the need for thorough histological and immunocytochemical examinations in LCH differential diagnosis.
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Affiliation(s)
- Ming Zhu
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, China
| | - Bing-Bing Yu
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, China
| | - Ji-Liang Zhai
- Department of Radiology, The Branch of Taian Central Hospital, Taian, China
| | - Gang Sun
- Department of Medical Imaging, Jinan Military General Hospital, Jinan, China
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Square-Wave Ocular Oscillation and Ataxia in an Anti-GAD–Positive Individual With Hypothyroidism. J Neuroophthalmol 2015; 35:390-5. [PMID: 26035807 DOI: 10.1097/wno.0000000000000275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Leguire LE, Kashou NH, Fogt N, Smith MA, Lewis JR, Kulwin R, Rogers GL. Neural circuit involved in idiopathic infantile nystagmus syndrome based on FMRI. J Pediatr Ophthalmol Strabismus 2011; 48:347-56. [PMID: 21261242 DOI: 10.3928/01913913-20110118-03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 12/30/2010] [Indexed: 12/19/2022]
Abstract
PURPOSE To identify the neural circuitry of idiopathic infantile nystagmus syndrome (INS), characterized by an early onset alternating series of slow and rapid eye movements that can manifest in different waveforms and genetic lines. The neural circuitry of INS is currently unknown. METHODS A novel functional magnetic resonance imaging (fMRI) method, referred to as the null zone fMRI technique, was used to identify the neural circuitry for INS. In the null zone fMRI technique, a gaze position with minimal nystagmus within the null zone was linked to the fMRI "off" condition and a gaze position with robust nystagmus outside of the null zone was linked to the fMRI "on" condition. Eye movements were monitored with an fMRI compatible eye tracker and observed in real time to ensure subject compliance in "on" and "off" states. Subjects with INS (n = 4) included three family members (a mother and two daughters) with presumed autosomal dominant INS, as well as age- and gender-matched normal controls (n = 3). RESULTS Three of four subjects with INS demonstrated significant increased activation of the declive of the cerebellum, whereas no normal subjects under identical conditions showed activation of the declive of the cerebellum. Both groups showed significant activation in the occipital lobe (Brodmann areas 17, 18, 19, and cuneus). CONCLUSION A novel fMRI method demonstrated that the declive of the cerebellum is actively involved in INS. These are the first results to identify the cerebellum, and specifically the declive, as a possible site involved in the ocular motor dysfunction known as INS.
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Affiliation(s)
- Lawrence E Leguire
- Departments of Ophthalmology, Nationwide Children’s Hospital, Columbus, Ohio, USA
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