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Kobayashi M. Clinical Differences between Radiographic and Physical Horizontal Gaze Deviation: Utility of Using the Two in Patients with Ischemic Stroke. Neurohospitalist 2024; 14:264-272. [PMID: 38895013 PMCID: PMC11181964 DOI: 10.1177/19418744241245748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Background and Purpose Radiographic horizontal gaze deviation (RHGD) has been identified as a useful finding on computed tomography (CT) that indicates the affected side in supratentorial ischemic stroke; however, it remains unclear whether RHGD is essentially the same phenomenon as physical horizontal gaze deviation (PHGD). To resolve the issue, this study was conducted. Methods Retrospective analyses were performed for 671 patients with ischemic stroke and 142 controls who were hospitalized and underwent head CT. First, clinical findings were examined to find differences between RHGD-positive and RHGD-negative patients. Second, patients were classified by their stroke mechanisms and/or affected vascular territories. For each subgroup, RHGD was compared with PHGD in frequency. Third, the proportions for patients divided by positivity for PHGD and RHGD were calculated in the subgroups. Results Patients with RHGD had PHGD more often than those without. In all stroke subgroups, RHGD was more frequent than PHGD. The frequency difference was prominent in small-artery occlusion (SAO) and posterior inferior cerebellar artery (PICA) stroke. In SAO of the basilar artery pontine perforator, RHGD was positive in 25% and largely contralesionally-directed. In PICA stroke, lesions in the vestibulocerebellum were associated with contralesional RHGD. Moreover, lesions in the lateral medulla also caused RHGD, which was mainly directed to the ipsilesional side. PHGD-positive stroke without RHGD was infrequent, whereas RHGD-positive stroke without PHGD was commonly observed (PICA stroke, 45.9%; other subgroups, 21.1%-27.5%). Conclusions RHGD had different characteristics from PHGD; therefore, assessments of both PHGD and RHGD may lead to more accurate diagnoses.
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Lunkova E, McCabe S, Chen JK, Saluja RS, Ptito A. Exploring oculomotor functions in a pilot study with healthy controls: Insights from eye-tracking and fMRI. PLoS One 2024; 19:e0303596. [PMID: 38905269 PMCID: PMC11192399 DOI: 10.1371/journal.pone.0303596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/26/2024] [Indexed: 06/23/2024] Open
Abstract
Eye-tracking techniques have gained widespread application in various fields including research on the visual system, neurosciences, psychology, and human-computer interaction, with emerging clinical implications. In this preliminary phase of our study, we introduce a pilot test of innovative virtual reality technology designed for tracking head and eye movements among healthy individuals. This tool was developed to assess the presence of mild traumatic brain injury (mTBI), given the frequent association of oculomotor function deficits with such injuries. Alongside eye-tracking, we also integrated fMRI due to the complementary nature of these techniques, offering insights into both neural activation patterns and behavioural responses, thereby providing a comprehensive understanding of oculomotor function. We used fMRI with tasks evaluating oculomotor functions: Smooth Pursuit (SP), Saccades, Anti-Saccades, and Optokinetic Nystagmus (OKN). Prior to the scanning, the testing with a system of VR goggles with integrated eye and head tracking was used where subjects performed the same tasks as those used in fMRI. 31 healthy adult controls (HCs) were tested with the purpose of identifying brain regions associated with these tasks and collecting preliminary norms for later comparison with concussed subjects. HCs' fMRI results showed following peak activation regions: SP-cuneus, superior parietal lobule, paracentral lobule, inferior parietal lobule (IPL), cerebellartonsil (CT); Saccades-middle frontal gyrus (MFG), postcentral gyrus, medial frontal gyrus; Anti-saccades-precuneus, IPL, MFG; OKN-middle temporal gyrus, ACC, postcentral gyrus, MFG, CT. These results demonstrated brain regions associated with the performance on oculomotor tasks in healthy controls and most of the highlighted areas are corresponding with those affected in concussion. This suggests that the involvement of brain areas susceptible to mTBI in implementing oculomotor evaluation, taken together with commonly reported oculomotor difficulties post-concussion, may lead to finding objective biomarkers using eye-tracking tasks.
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Affiliation(s)
- Ekaterina Lunkova
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Sarah McCabe
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Jen-Kai Chen
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Rajeet Singh Saluja
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
- McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Alain Ptito
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
- Montreal Neurological Institute, Montreal, Quebec, Canada
- Department of Psychology, McGill University Health Centre, Montreal, Quebec, Canada
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3
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Garces P, Antoniades CA, Sobanska A, Kovacs N, Ying SH, Gupta AS, Perlman S, Szmulewicz DJ, Pane C, Németh AH, Jardim LB, Coarelli G, Dankova M, Traschütz A, Tarnutzer AA. Quantitative Oculomotor Assessment in Hereditary Ataxia: Systematic Review and Consensus by the Ataxia Global Initiative Working Group on Digital-motor Biomarkers. CEREBELLUM (LONDON, ENGLAND) 2024; 23:896-911. [PMID: 37117990 PMCID: PMC11102387 DOI: 10.1007/s12311-023-01559-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 04/30/2023]
Abstract
Oculomotor deficits are common in hereditary ataxia, but disproportionally neglected in clinical ataxia scales and as outcome measures for interventional trials. Quantitative assessment of oculomotor function has become increasingly available and thus applicable in multicenter trials and offers the opportunity to capture severity and progression of oculomotor impairment in a sensitive and reliable manner. In this consensus paper of the Ataxia Global Initiative Working Group On Digital Oculomotor Biomarkers, based on a systematic literature review, we propose harmonized methodology and measurement parameters for the quantitative assessment of oculomotor function in natural-history studies and clinical trials in hereditary ataxia. MEDLINE was searched for articles reporting on oculomotor/vestibular properties in ataxia patients and a study-tailored quality-assessment was performed. One-hundred-and-seventeen articles reporting on subjects with genetically confirmed (n=1134) or suspected hereditary ataxia (n=198), and degenerative ataxias with sporadic presentation (n=480) were included and subject to data extraction. Based on robust discrimination from controls, correlation with disease-severity, sensitivity to change, and feasibility in international multicenter settings as prerequisite for clinical trials, we prioritize a core-set of five eye-movement types: (i) pursuit eye movements, (ii) saccadic eye movements, (iii) fixation, (iv) eccentric gaze holding, and (v) rotational vestibulo-ocular reflex. We provide detailed guidelines for their acquisition, and recommendations on the quantitative parameters to extract. Limitations include low study quality, heterogeneity in patient populations, and lack of longitudinal studies. Standardization of quantitative oculomotor assessments will facilitate their implementation, interpretation, and validation in clinical trials, and ultimately advance our understanding of the evolution of oculomotor network dysfunction in hereditary ataxias.
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Affiliation(s)
- Pilar Garces
- Roche Pharma Research and Early Development, Neuroscience and Rare Diseases, Roche Innovation Center Basel, Basel, Switzerland
| | - Chrystalina A Antoniades
- NeuroMetrology Lab, Nuffield Department of Clinical Neurosciences, Clinical Neurology, Medical Sciences Division, University of Oxford, Oxford, OX3 9DU, UK
| | - Anna Sobanska
- Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Norbert Kovacs
- Department of Neurology, University of Pécs, Medical School, Pécs, Hungary
| | - Sarah H Ying
- Department of Otology and Laryngology and Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Anoopum S Gupta
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susan Perlman
- University of California Los Angeles, Los Angeles, California, USA
| | - David J Szmulewicz
- Balance Disorders and Ataxia Service, Royal Victoria Eye and Ear Hospital, East Melbourne, Melbourne, VIC, 3002, Australia
- The Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, VIC, 3052, Australia
| | - Chiara Pane
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Andrea H Németh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Laura B Jardim
- Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Genética Médica/Centro de Pesquisa Clínica e Experimental, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Giulia Coarelli
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm U1127, CNRS UMR7225, Paris, France
- Department of Genetics, Neurogene National Reference Centre for Rare Diseases, Pitié-Salpêtrière University Hospital, Assistance Publique, Hôpitaux de Paris, Paris, France
| | - Michaela Dankova
- Department of Neurology, Centre of Hereditary Ataxias, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Andreas Traschütz
- Research Division "Translational Genomics of Neurodegenerative Diseases", Hertie-Institute for Clinical Brain Research and Center of Neurology, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Alexander A Tarnutzer
- Neurology, Cantonal Hospital of Baden, 5404, Baden, Switzerland.
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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Sekar A, Panouillères MTN, Kaski D. Detecting Abnormal Eye Movements in Patients with Neurodegenerative Diseases - Current Insights. Eye Brain 2024; 16:3-16. [PMID: 38617403 PMCID: PMC11015840 DOI: 10.2147/eb.s384769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/23/2024] [Indexed: 04/16/2024] Open
Abstract
This review delineates the ocular motor disturbances across a spectrum of neurodegenerative disorders, including Alzheimer's Disease (AD) and related disorders (ADRD), Parkinson's Disease (PD), atypical parkinsonism, and others, leveraging advancements in eye-tracking technology for enhanced diagnostic precision. We delve into the different classes of eye movements, their clinical assessment, and specific abnormalities manifesting in these diseases, highlighting the nuanced differences and shared patterns. For instance, AD and ADRD are characterized by increased saccadic latencies and instability in fixation, while PD features saccadic hypometria and mild smooth pursuit impairments. Atypical parkinsonism, notably Progressive Supranuclear Palsy (PSP) and Corticobasal Syndrome (CBS), presents with distinct ocular motor signatures such as vertical supranuclear gaze palsy and saccadic apraxia, respectively. Our review underscores the diagnostic value of eye movement analysis in differentiating between these disorders and also posits the existence of underlying common pathological mechanisms. We discuss how eye movements have potential as biomarkers for neurodegenerative diseases but also some of the existing limitations.
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Affiliation(s)
- Akila Sekar
- SENSE Research Unit, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Muriel T N Panouillères
- NeuroClues, Ottignies-Louvain-la-Neuve, Belgium
- CIAMS, Université Paris-Saclay, Orsay, France
| | - Diego Kaski
- SENSE Research Unit, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
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Hickman JL, Lafreniere M, Bennett JL, Forbes E, Feuerstein J. Periodic Alternating Nystagmus, Ataxia, and Spasticity: A Unique Presentation of Spastic Paraplegia 7-Related Hereditary Spastic Paraplegia. Mov Disord Clin Pract 2024; 11:441-443. [PMID: 38396346 PMCID: PMC10982591 DOI: 10.1002/mdc3.13991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/21/2023] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Affiliation(s)
- Jordan L. Hickman
- Medical Scientist Training ProgramUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Marrisa Lafreniere
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Jeffrey L. Bennett
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- Department of OphthalmologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Emily Forbes
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Jeanne Feuerstein
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- Department of NeurologyRocky Mountain Regional VA Medical CenterAuroraColoradoUSA
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6
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Palacios ER, Chadderton P, Friston K, Houghton C. Cerebellar state estimation enables resilient coupling across behavioural domains. Sci Rep 2024; 14:6641. [PMID: 38503802 PMCID: PMC10951354 DOI: 10.1038/s41598-024-56811-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
Cerebellar computations are necessary for fine behavioural control and may rely on internal models for estimation of behaviourally relevant states. Here, we propose that the central cerebellar function is to estimate how states interact with each other, and to use these estimates to coordinates extra-cerebellar neuronal dynamics underpinning a range of interconnected behaviours. To support this claim, we describe a cerebellar model for state estimation that includes state interactions, and link this model with the neuronal architecture and dynamics observed empirically. This is formalised using the free energy principle, which provides a dual perspective on a system in terms of both the dynamics of its physical-in this case neuronal-states, and the inferential process they entail. As a demonstration of this proposal, we simulate cerebellar-dependent synchronisation of whisking and respiration, which are known to be tightly coupled in rodents, as well as limb and tail coordination during locomotion. In summary, we propose that the ubiquitous involvement of the cerebellum in behaviour arises from its central role in precisely coupling behavioural domains.
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Affiliation(s)
- Ensor Rafael Palacios
- University of Bristol, School of Physiology Pharmacology and Neuroscience, Bristol, BS8 1TD, UK.
| | - Paul Chadderton
- University of Bristol, School of Physiology Pharmacology and Neuroscience, Bristol, BS8 1TD, UK
| | - Karl Friston
- UCL, Wellcome Centre for Human Neuroimaging, London, WC1N 3AR, UK
| | - Conor Houghton
- University of Bristol, Department of Computer Science, Bristol, BS8 1UB, UK
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7
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Cullen KE. Internal models of self-motion: neural computations by the vestibular cerebellum. Trends Neurosci 2023; 46:986-1002. [PMID: 37739815 PMCID: PMC10591839 DOI: 10.1016/j.tins.2023.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/15/2023] [Accepted: 08/25/2023] [Indexed: 09/24/2023]
Abstract
The vestibular cerebellum plays an essential role in maintaining our balance and ensuring perceptual stability during activities of daily living. Here I examine three key regions of the vestibular cerebellum: the floccular lobe, anterior vermis (lobules I-V), and nodulus and ventral uvula (lobules X-IX of the posterior vermis). These cerebellar regions encode vestibular information and combine it with extravestibular signals to create internal models of eye, head, and body movements, as well as their spatial orientation with respect to gravity. To account for changes in the external environment and/or biomechanics during self-motion, the neural mechanisms underlying these computations are continually updated to ensure accurate motor behavior. To date, studies on the vestibular cerebellum have predominately focused on passive vestibular stimulation, whereas in actuality most stimulation is the result of voluntary movement. Accordingly, I also consider recent research exploring these computations during active self-motion and emerging evidence establishing the cerebellum's role in building predictive models of self-generated movement.
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Affiliation(s)
- Kathleen E Cullen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD 21205, USA; Department of Neuroscience, Johns Hopkins University, Baltimore, MD 21205, USA; Kavli Neuroscience Discovery Institute, Johns Hopkins University, Baltimore, MD 21205, USA.
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8
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Roberts LJ, Szmulewicz DJ. A patient with neuropathy and ataxia: what do I have to consider? Curr Opin Neurol 2023; 36:382-387. [PMID: 37639448 DOI: 10.1097/wco.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW An increasing number of peripheral neuro(no)pathies are identified as involving other components of the neurological system, particularly those that further impair balance. Here we aim to outline an evidence-based approach to the diagnosis of patients who present with a somatosensory disorder which also involves at least one other area of neurological impairment such as the vestibular, auditory, or cerebellar systems. RECENT FINDINGS Detailed objective investigation of patients who present with sensory impairment, particularly where the degree of imbalance is greater than would be expected, aids the accurate diagnosis of genetic, autoimmune, metabolic, and toxic neurological disease. SUMMARY Diagnosis and management of complex somatosensory disorders benefit from investigation which extends beyond the presenting sensory impairment.
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Affiliation(s)
- Leslie J Roberts
- Neurophysiology Department, Department of Neurology & Neurological Research, St Vincent's Hospital, Department of Medicine, the University of Melbourne
| | - David J Szmulewicz
- Balance Disorders and Ataxia Service, Eye and Ear Hospital
- Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria, Australia
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9
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Caldani S, Humeau E, Delorme R, Bucci MP. Inhibition functions can be improved in children with autism spectrum disorders: An eye-tracking study. Int J Dev Neurosci 2023; 83:431-441. [PMID: 37218472 DOI: 10.1002/jdn.10276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/17/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
Cognitive remediation therapy interventions could improve cognitive functioning in subjects with autism. To investigate the benefit of a short cognitive training rehabilitation in children with autism spectrum disorder (ASD) on pursuit and fixation performances. We recruited two groups (G1 and G2) of 30 children with ASD, sex-, IQ- and age-matched (mean 11.6 ± 0.5 years), and pursuit and fixation eye movements were recorded twice at T1 and T2. Between T1 and T2, a 10-min cognitive training was performed by the G1 group only, whereas the G2 group had a 10-min of rest. For all children with ASD enrolled in the study, there was a positive correlation between restricted and repetitive behaviour scores of both Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) and the number of saccades recorded during the fixation task at T1. At T1, oculomotor performances were similar for both groups of ASD children (G1 and G2). At T2, we observed a significant reduction in the number of saccades made during both pursuit and fixation tasks. Our findings underlined the importance to promote cognitive training rehabilitation for children with ASD, leading to a better performance in inhibitory and attention functioning responsible for pursuit and fixation eye movement's performance.
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Affiliation(s)
- Simona Caldani
- MoDyCo, UMR 7114 CNRS, Paris Nanterre University, Nanterre, France
- EFEE-Center for the Functional Exploration of Balance in Children, Robert Debré Hospital, Paris, France
| | - Elise Humeau
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
- High Functioning Autism Expert Centre, Fundamental Fondation, Paris, France
- Paris University, Paris, France
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
- High Functioning Autism Expert Centre, Fundamental Fondation, Paris, France
- Paris University, Paris, France
| | - Maria Pia Bucci
- MoDyCo, UMR 7114 CNRS, Paris Nanterre University, Nanterre, France
- EFEE-Center for the Functional Exploration of Balance in Children, Robert Debré Hospital, Paris, France
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10
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Scheveig F, Bucci MP. Postural and Proprioceptive Deficits Clinically Assessed in Children with Reading Disabilities: A Case-Control Study. Vision (Basel) 2023; 7:vision7020037. [PMID: 37218955 DOI: 10.3390/vision7020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Several studies have reported motor deficiencies in children with dyslexia, in line with the cerebellar deficit theory. In the present study, we explored whether tests used by physiotherapists during clinical evaluation were able to report motor deficits in a group of fifty-six dyslexic children (mean age 10.9 ± 0.2 years old) compared to a group of thirty-eight non-dyslexic children (mean age 11.2 ± 0.4 years old). The occurrence of instability on an unstable support; spinal instability in the sagittal, frontal and horizontal plane; head-eye discoordination; and poor eye stability were clinically assessed in the two groups of children. All such measures were found to be significantly more frequent in dyslexic than in non-dyslexic children (p < 0.001, p < 0.05, p < 0.001 and p < 0.001, respectively, for occurrence of instability on an unstable support, spinal instability, head-eye discoordination and poor eye stability). These results, firstly, confirmed the poor motor control of dyslexic children, suggesting deficient cerebellar integration. Secondly, for the first time, we reported that simple tests that can be done by pediatricians and/or during a clinical routine evaluation could be useful to discriminate children with reading difficulties. The tests used in this study could be a reference for a first exploration of motor deficiencies in children with dyslexia that can be easily assessed by clinicians and/or physiotherapists.
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Affiliation(s)
- Franck Scheveig
- Clinique de Posturologie, 66100 Perpignan, France
- MoDyCo, UMR 7114 CNRS Université Paris Nanterre, 92000 Nanterre, France
| | - Maria Pia Bucci
- MoDyCo, UMR 7114 CNRS Université Paris Nanterre, 92000 Nanterre, France
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11
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Matsugi A. Cerebellar TMS Induces Motor Responses Mediating Modulation of Spinal Excitability: A Literature Review. Brain Sci 2023; 13:brainsci13040531. [PMID: 37190496 DOI: 10.3390/brainsci13040531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 05/17/2023] Open
Abstract
Since individuals with cerebellar lesions often exhibit hypotonia, the cerebellum may contribute to the regulation of muscle tone and spinal motoneuron pool excitability. Neurophysiological methods using transcranial magnetic stimulation (TMS) of the cerebellum have been recently proposed for testing the role of the cerebellum in spinal excitability. Under specific conditions, single-pulse TMS administered to the cerebellar hemisphere or vermis elicits a long-latency motor response in the upper or lower limb muscles and facilitates the H-reflex of the soleus muscle, indicating increased excitability of the spinal motoneuron pool. This literature review examined the methods and mechanisms by which cerebellar TMS modulates spinal excitability.
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Affiliation(s)
- Akiyoshi Matsugi
- Faculty of Rehabilitation, Shijonawate Gakuen University, Osaka 574-0011, Japan
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12
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Getz DR, Mangalampalli A, Klopfenstein J, Tsung AJ, Kattah JC. Role of bedside video-oculography in selecting neuroimaging in patients with acute vertigo and ataxia posterior fossa mass lesions. J Neurol Sci 2023; 444:120513. [PMID: 36502577 DOI: 10.1016/j.jns.2022.120513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/06/2022] [Accepted: 11/26/2022] [Indexed: 12/04/2022]
Affiliation(s)
- Daniel R Getz
- Department of Neurology, University of Illinois College of Medicine and the Illinois Neurologic Institute Peoria, IL, United States of America
| | - Anusha Mangalampalli
- Department of Neurology, University of Illinois College of Medicine and the Illinois Neurologic Institute Peoria, IL, United States of America
| | - Jeffrey Klopfenstein
- Department of Neurosurgery, University of Illinois College of Medicine and the Illinois Neurologic Institute Peoria, IL, United States of America
| | - Andrew J Tsung
- Department of Neurosurgery, University of Illinois College of Medicine and the Illinois Neurologic Institute Peoria, IL, United States of America
| | - Jorge C Kattah
- Department of Neurology, University of Illinois College of Medicine and the Illinois Neurologic Institute Peoria, IL, United States of America; Department of Neurosurgery, University of Illinois College of Medicine and the Illinois Neurologic Institute Peoria, IL, United States of America.
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13
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Fracica E, Hale D, Gold DR. Diagnosing and localizing the acute vestibular syndrome - Beyond the HINTS exam. J Neurol Sci 2022; 442:120451. [PMID: 36270149 DOI: 10.1016/j.jns.2022.120451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/11/2022] [Accepted: 10/02/2022] [Indexed: 10/31/2022]
Abstract
When assessing the acutely dizzy patient, the HINTS 'Plus' (Head Impulse, Nystagmus, Test of Skew, 'Plus' a bedside assessment of auditory function) exam is a crucial component of the bedside exam. However, there are additional ocular motor findings that can help the clinician distinguish peripheral from central etiologies and enable accurate localization, especially when the patient has acute dizziness, vertigo and/or imbalance but without spontaneous nystagmus. We will review the literature on these findings which are 'beyond HINTS' and include saccades/ocular lateropulsion, smooth pursuit, and provocative maneuvers including head-shaking and positional testing (not part of the HINTS exam). Additionally, we will expound on the localizing value of nystagmus, ocular alignment and the ocular tilt reaction (parts of the HINTS exam). The paper has been organized neuroanatomically, based on brainstem and cerebellar structures that have been reported to cause the acute vestibular syndrome.
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Affiliation(s)
- Elizabeth Fracica
- The Johns Hopkins Hospital, Department of Neurology, United States of America.
| | - David Hale
- The Johns Hopkins Hospital, Department of Neurology, United States of America
| | - Daniel R Gold
- The Johns Hopkins Hospital, Department of Neurology, United States of America; The Johns Hopkins Hospital, Department of Neurology, Division of Neuro-Visual & Vestibular Disorders, United States of America
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14
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García Cena CE, Gómez-Andrés D, Pulido-Valdeolivas I, Sánchez-Seco VG, Domingo-Santos A, Moreno-García S, Benito-León J. Toward an Automatic Assessment of Cognitive Dysfunction in Relapsing-Remitting Multiple Sclerosis Patients Using Eye Movement Analysis. SENSORS (BASEL, SWITZERLAND) 2022; 22:8220. [PMID: 36365918 PMCID: PMC9657913 DOI: 10.3390/s22218220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/13/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
Despite the importance of cognitive function in multiple sclerosis, it is poorly represented in the Expanded Disability Status Scale (EDSS), the commonly used clinical measure to assess disability, suggesting that an analysis of eye movement, which is generated by an extensive and well-coordinated functional network that is engaged in cognitive function, could have the potential to extend and complement this more conventional measure. We aimed to measure the eye movement of a case series of MS patients with relapsing−remitting MS to assess their cognitive status using a conventional gaze tracker. A total of 41 relapsing−remitting MS patients and 43 age-matched healthy controls were recruited for this study. Overall, we could not find a clear common pattern in the eye motor abnormalities. Vertical eye movement was more impaired in MS patients than horizontal movement. Increased latencies were found in the prosaccades and reflexive saccades of antisaccade tests. The smooth pursuit was impaired with more corrections (backup and catchup movements, p<0.01). No correlation was found between eye movement variables and EDSS or disease duration. Despite significant alterations in the behavior of the eye movements in MS patients, which are compatible with altered cognitive status, there is no common pattern of these alterations. We interpret this as a consequence of the patchy, heterogeneous distribution of white matter involvement in MS that provokes multiple combinations of impairment at different points in the different networks involved in eye motor control. Further studies are therefore required.
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Affiliation(s)
- Cecilia E. García Cena
- Escuela Técnica Superior de Ingeniería y Diseño Industrial, Centre for Automation and Robotics, ETSIDI-CAR, Universidad Politécnica de Madrid, 28012 Madrid, Spain
| | - David Gómez-Andrés
- Child Neurology Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), Euro-NMD and ERN-RND, 08035 Barcelona, Spain
| | - Irene Pulido-Valdeolivas
- Anatomy, Histology and Neuroscience Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | | | - Angela Domingo-Santos
- Department of Neurology, “La Mancha Centro” General Hospital, Alcázar de San Juan, 13600 Ciudad Real, Spain
| | - Sara Moreno-García
- Department of Neurology, University Hospital “12 de Octubre”, 28041 Madrid, Spain
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, 28041 Madrid, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28029 Madrid, Spain
- Department of Medicine, Complutense University, 28040 Madrid, Spain
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15
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Rosenthal LS. Neurodegenerative Cerebellar Ataxia. Continuum (Minneap Minn) 2022; 28:1409-1434. [DOI: 10.1212/con.0000000000001180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Helmchen C, Machner B, Schwenke H, Sprenger A. Bilateral lesion of the cerebellar fastigial nucleus: Effects on smooth pursuit acceleration and non-reflexive visually-guided saccades. Front Neurol 2022; 13:883213. [PMID: 36203994 PMCID: PMC9530709 DOI: 10.3389/fneur.2022.883213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background“Central dizziness” due to acute bilateral midline cerebellar disease sparing the posterior vermis has specific oculomotor signs. The oculomotor region of the cerebellar fastigial nucleus (FOR) crucially controls the accuracy of horizontal visually-guided saccades and smooth pursuit eye movements. Bilateral FOR lesions elicit bilateral saccade hypermetria with preserved pursuit. It is unknown whether the initial acceleration of smooth pursuit is impaired in patients with bilateral FOR lesions.ObjectiveWe studied the effect of a cerebellar lesion affecting the deep cerebellar nuclei on the initial horizontal pursuit acceleration and investigated whether saccade dysmetria also affects other types of volitional saccades, i.e., memory-guided saccades and anti-saccades, which are not performed in immediate response to the visual target.MethodsWe recorded eye movements during a sinusoidal and step-ramp target motion paradigm as well as visually-guided saccades, memory-guided saccades, and anti-saccades in one patient with a circumscribed cerebellar hemorrhage and 18 healthy control subjects using a video-based eye tracker.ResultsThe lesion comprised the FOR bilaterally but spared the posterior vermis. The initial pursuit acceleration was low but not significantly different from the healthy control subjects and sinusoidal pursuit was normal. Bilateral saccade hypermetria was not only seen with visually-guided saccades but also with anti-saccades and memory-guided saccades. The final eye position remained accurate.ConclusionWe provide new insights into the contribution of the bilateral deep cerebellar nuclei on the initial acceleration of human smooth pursuit in midline cerebellar lesions. In line with experimental bilateral FOR lesion data in non-human primates, the initial pursuit acceleration in our patient was not significantly reduced, in contrast to the effects of unilateral experimental FOR lesions. Working memory and neural representation of target locations seem to remain unimpaired. Our data argue against an impaired common command feeding the circuits controlling saccadic and pursuit eye movements and support the hypothesis of independent influences on the neural processes generating both types of eye movements in the deep cerebellar nuclei.
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Affiliation(s)
- Christoph Helmchen
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- *Correspondence: Christoph Helmchen
| | - Björn Machner
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Hannes Schwenke
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- Department of Neuroradiology, University Hospitals Schleswig-Holstein, Lübeck, Germany
| | - Andreas Sprenger
- Department of Neurology, University Hospitals Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- Institute of Psychology II, University of Lübeck, Lübeck, Germany
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Monitoring Eye Movements Depending on the Type of Visual Stimulus in Patients with Impaired Consciousness Due to Brain Damage. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106280. [PMID: 35627817 PMCID: PMC9140856 DOI: 10.3390/ijerph19106280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 02/06/2023]
Abstract
The eyeballs are often the only way to communicate messages as a result of brain damage. However, it is not uncommon for them to become dysfunctional, thus requiring the introduction of appropriate therapy. The trajectory of eye movements (saccadic movements and gaze fixation) during observation of a static and dynamic point presented with an eye tracker was analyzed in the present study. Twelve patients with brain injury of different etiology, with different degrees of consciousness disorders and not communicating through verbal and motor skills, qualified for the study. All participants demonstrated greater eye movement activity when presented with a dynamic task in which they observed a moving point. The findings suggest that effective eye movement therapy must incorporate dynamic stimuli.
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Chen RB, Zhong YL, Huang X. The predictive value of local to remote functional connectivity changes in comitant exotropia patients. Neuroreport 2022; 33:259-265. [PMID: 35383657 DOI: 10.1097/wnr.0000000000001777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Comitant exotropia (CE) is a common eye disease with abnormal eye movement, whereas altered synchronous neural activity in CE patients is poorly understood. The purpose of our study was to investigate local to remote functional connectivity of blood oxygen level-dependent (BOLD) signals changes in CE patients. MATERIAL AND METHODS Thirty-four patients and thirty-four healthy controls (HCs) underwent resting-state MRI scans. The ReHo and FC method was applied to investigate the local to remote functional connectivity changes in CE patients. RESULTS Compared to the HC group, CE patients showed significant increased ReHo values in the left cerebellar_crus2 and left middle frontal gyrus. Meanwhile, CE patients showed significant decreased ReHo values in the right middle temporal gyrus, left postcentral gyrus and right angular. Moreover, CE patients showed an increased FC between the cerebellar network, sensorimotor network (SMN) and default-mode network (DMN). The support vector machine (SVM) classification was up to a total accuracy of 94.12%. The AUC of the classification model was 0.99 on the basis of ReHo map. CONCLUSION Our result highlights that CE patients had abnormal local to remote functional connectivity in the cerebellar network, SMN, DMN, which might indicate the neural mechanism of eye movements and stereo vision dysfunction in CE patients. Moreover, the SVM algorithm reveals ReHo maps as a potential biomarker for predicting clinical outcomes in CE patients.
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Affiliation(s)
| | - Yu-Lin Zhong
- Department of Ophthalmology, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China
| | - Xin Huang
- Department of Ophthalmology, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China
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Robinson DA. Neurophysiology of the optokinetic system. PROGRESS IN BRAIN RESEARCH 2022; 267:251-269. [PMID: 35074057 DOI: 10.1016/bs.pbr.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This chapter provides a review of early studies into the neural substrate for optokinetic-vestibular responses. Properties and connections of retinal and brainstem neurons contributing to optokinetic responses in the afoveate rabbit are summarized. Electrophysiological and lesion studies provide support for confluence of optokinetic and vestibular signals in the vestibular nucleus to provide the brain's estimate of self-rotation. Evidence for optokinetic-vestibular symbiosis in humans comes from the observation that individuals who have lost vestibular function show no optokinetic after-nystagmus in darkness, following full-field stimulus motion. An anatomical scheme for brainstem elaboration of optokinetic responses is proposed and cerebellar contributions are reviewed.
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Affiliation(s)
- David A Robinson
- Late Professor of Ophthalmology, Biomedical Engineering and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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20
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Basic framework of the vestibulo-ocular reflex. PROGRESS IN BRAIN RESEARCH 2022; 267:131-153. [DOI: 10.1016/bs.pbr.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Vogelaar FA, Brandsma R, Maurits NM, Sival DA. Applicability of quantitative oculomotor and SARA assessment in children. Eur J Paediatr Neurol 2021; 35:56-60. [PMID: 34610562 DOI: 10.1016/j.ejpn.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/13/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND In clinical practice, eye movements can provide an early diagnostic marker for early onset ataxia (EOA). However, quantitative oculomotor assessment is not included in the most frequently used and age-validated ataxia rating scale in children, the Scale for the Assessment and Rating of Ataxia (SARA). We aimed to investigate the applicability of semi-quantitative eye movement assessment by the International Cooperative Ataxia Rating Scale (ICARSOCM) and Ocular Motion Score (OMS7-10) complementary to SARA measurements in children. METHODS In 52 typically developing children (aged 4-16 years; n = 4 per year of age), three independent assessors scored saccadic eye movements and ocular pursuit according to the ICARSOCM and matching parameters from the OMS7-10. For ICARSOCM, we determined 1) construct validity for coordinated eye movements by correlation with OMS7-10, ICARSEYE-HAND-COORDINATION and SARA subscale scores, 2) agreement percentage and inter-rater agreement (Fleiss Kappa) and 3) age-dependency. RESULTS Spearman's rank correlations of ICARSOCM with OMS7-10 and ICARS- and SARA subscales were moderate to fair (all p < .001). Inter-rater agreement of ICARS-OCM was 80.8%; (Fleiss Kappa: 0.411). ICARSOCM scores revealed a similar exponentially decreasing association with age as the other SARA (sub)scores, reaching a plateau at 10 years of age. INTERPRETATION ICARSOCM has a valid construct for the measurement of coordinated eye movement performance and is reliably assessable in children. ICARSOCM reveals a similar age-dependent relationship as the other ataxia subscales, reflecting the physiological maturation of the cerebellum. In children, these data may implicate that ICARSOCM can reliably contribute to coordination assessment, complementary to the SARA subscales.
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Affiliation(s)
- Francien A Vogelaar
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands
| | - Rick Brandsma
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Department of Paediatric Neurology, Utrecht, the Netherlands
| | - Natasha M Maurits
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, the Netherlands
| | - Deborah A Sival
- University of Groningen, University Medical Center Groningen, Department of Paediatric Neurology, Beatrix Children's Hospital, Groningen, the Netherlands.
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An infrequent type of nystagmus during a vertigo crisis in Meniére's disease. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Shemesh AA, Kocoglu K, Akdal G, Ala RT, Halmagyi GM, Zee DS, Otero-Millan J. Modeling the interaction among three cerebellar disorders of eye movements: periodic alternating, gaze-evoked and rebound nystagmus. J Comput Neurosci 2021; 49:295-307. [PMID: 34003422 PMCID: PMC9169448 DOI: 10.1007/s10827-021-00790-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
A woman, age 44, with a positive anti-YO paraneoplastic cerebellar syndrome and normal imaging developed an ocular motor disorder including periodic alternating nystagmus (PAN), gaze-evoked nystagmus (GEN) and rebound nystagmus (RN). During fixation there was typical PAN but changes in gaze position evoked complex, time-varying oscillations of GEN and RN. To unravel the pathophysiology of this unusual pattern of nystagmus, we developed a mathematical model of normal function of the circuits mediating the vestibular-ocular reflex and gaze-holding including their adaptive mechanisms. Simulations showed that all the findings of our patient could be explained by two, small, isolated changes in cerebellar circuits: reducing the time constant of the gaze-holding integrator, producing GEN and RN, and increasing the gain of the vestibular velocity-storage positive feedback loop, producing PAN. We conclude that the gaze- and time-varying pattern of nystagmus in our patient can be accounted for by superposition of one model that produces typical PAN and another model that produces typical GEN and RN, without requiring a new oscillator in the gaze-holding system or a more complex, nonlinear interaction between the two models. This analysis suggest a strategy for uncovering gaze-evoked and rebound nystagmus in the setting of a time-varying nystagmus such as PAN. Our results are also consistent with current ideas of compartmentalization of cerebellar functions for the control of the vestibular velocity-storage mechanism (nodulus and ventral uvula) and for holding horizontal gaze steady (the flocculus and tonsil).
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Affiliation(s)
- Ari A Shemesh
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Koray Kocoglu
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Gülden Akdal
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, İzmir, Turkey
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Rahmi Tümay Ala
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - G Michael Halmagyi
- Department of Neurology, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - David S Zee
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Departments of Ophthalmology, Otolaryngology-Head and Neck Surgery and Neuroscience, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jorge Otero-Millan
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- School of Optometry, University of California Berkeley, Berkeley, CA, USA.
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Mantokoudis G, Korda A, Zee DS, Zamaro E, Sauter TC, Wagner F, Caversaccio MD. Bruns' nystagmus revisited: A sign of stroke in patients with the acute vestibular syndrome. Eur J Neurol 2021; 28:2971-2979. [PMID: 34176187 PMCID: PMC8456911 DOI: 10.1111/ene.14997] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 11/29/2022]
Abstract
Objective Gaze‐evoked nystagmus (GEN) is a central sign in patients with the acute vestibular syndrome (AVS); however, discriminating between a pathological and a physiologic GEN is a challenge. Here we evaluate GEN in patients with AVS. Methods In this prospective cross‐sectional study, we used video‐oculography (VOG) to compare GEN in the light (target at 15° eccentric) in 64 healthy subjects with 47 patients seen in the emergency department (ED) who had AVS; 35 with vestibular neuritis and 12 with stroke. All patients with an initial non‐diagnostic MRI received a confirmatory, delayed MRI as a reference standard in detecting stroke. Results Healthy subjects with GEN had a time constant of centripetal drift >18 s. VOG identified pathologic GEN (time constant ≤ 18 s) in 33% of patients with vestibular strokes, specificity was 100%, accuracy was 83%. Results were equivalent to examination by a clinical expert. As expected, since all patients with GEN had a SN in straight‐ahead position, they showed the pattern of a Bruns’ nystagmus. Conclusions One third of patients with AVS due to central vestibular strokes had a spontaneous SN in straight‐ahead gaze and a pathological GEN, producing the pattern of a Bruns’ nystagmus with a shift of the null position. The localization of the side of the lesion based on the null was not consistent, presumably because the circuits underlying gaze‐holding are widespread in the brainstem and cerebellum. Nevertheless, automated quantification of GEN with VOG was specific, and accurately identified patients in the ED with AVS due to strokes.
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Affiliation(s)
- Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David S Zee
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas C Sauter
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Franca Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Zhang S, Gao GP, Shi WQ, Li B, Lin Q, Shu HY, Shao Y. Abnormal interhemispheric functional connectivity in patients with strabismic amblyopia: a resting-state fMRI study using voxel-mirrored homotopic connectivity. BMC Ophthalmol 2021; 21:255. [PMID: 34107904 PMCID: PMC8188699 DOI: 10.1186/s12886-021-02015-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/13/2021] [Indexed: 11/11/2022] Open
Abstract
Background Previous studies have demonstrated that strabismus amblyopia can result in markedly brain function alterations. However, the differences in spontaneous brain activities of strabismus amblyopia (SA) patients still remain unclear. Therefore, the current study intended to employthe voxel-mirrored homotopic connectivity (VMHC) method to investigate the intrinsic brain activity changes in SA patients. Purpose To investigate the changes in cerebral hemispheric functional connections in patients with SA and their relationship with clinical manifestations using the VMHC method. Material and methods In the present study, a total of 17 patients with SA (eight males and nine females) and 17 age- and weight-matched healthy control (HC) groups were enrolled. Based on the VMHC method, all subjects were examined by functional magnetic resonance imaging. The functional interaction between cerebral hemispheres was directly evaluated. The Pearson’s correlation test was used to analyze the clinical features of patients with SA. In addition, their mean VMHC signal values and the receiver operating characteristic curve were used to distinguish patients with SA and HC groups. Results Compared with HC group, patients with SA had higher VMHC values in bilateral cingulum ant, caudate, hippocampus, and cerebellum crus 1. Moreover, the VMHC values of some regions were positively correlated with some clinical manifestations. In addition, receiver operating characteristic curves presented higher diagnostic value in these areas. Conclusion SA subjects showed abnormal brain interhemispheric functional connectivity in visual pathways, which might give some instructive information for understanding the neurological mechanisms of SA patients.
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Affiliation(s)
- Shuang Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Gui-Ping Gao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wen-Qing Shi
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Biao Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qi Lin
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hui-Ye Shu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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Clinical Prevalence of Enhanced Vestibulo-Ocular Reflex Responses on Video Head Impulse Test. Otol Neurotol 2021; 42:e1160-e1169. [PMID: 33993145 DOI: 10.1097/mao.0000000000003171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To measure and analyze the clinical and epidemiological characteristics of patients and healthy controls with enhanced eye velocity responses as well as evaluate their relationship with endolymphatic hydrops related diseases. STUDY DESIGN Cross-sectional clinical study. SETTING Tertiary hospital. PARTICIPANTS Three hundred sixty three participants allocated to patients (310) and healthy control (53) groups were collected on first time visit to neurotology unit. INTERVENTION Diagnostic. MAIN OUTCOME MEASURES Video head impulse test records, clinical diagnose, and variables and demographic data were used to get cross tables, a general linear model, diagnostic epidemiological parameters, and machine learning variable importance evaluation methods. RESULTS All the statistical tests revealed a significant association between enhanced vestibulo-ocular reflex (VOR) and diagnostic categories (p < 0.001). Chi-squared residual and machine learning analyses showed Menière's disease as the main associated diagnostic category, whereas the lowest residuals and gain values were found in the control group. Enhanced VOR as a diagnostic sign of Menière's disease had a sensitivity of 42.59% and a specificity of 86.32%, with an odds ratio of 4.68 (p < 0.001). CONCLUSION There is a significantly higher prevalence of enhanced VOR responses in patients with Menière's disease, central origin vertigo, otosclerosis, and vestibular migraine than in those with other neurotologic diseases and controls. Our study found that enhanced VOR are not pathognomonic of hydrops-related diseases and the diagnosis should not solely be based on these and instead take into context other clinical and examination findings.
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Uyaroglu FG, Ucar R, Acarer A, Celebisoy N. What might cervical vestibular-evoked myogenic potential abnormalities mean in essential tremor? Neurol Sci 2021; 42:5271-5276. [PMID: 33860393 DOI: 10.1007/s10072-021-05248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
AIM/BACKGROUND Essential tremor (ET) is one of the most common movement disorders. However, its pathogenesis is unclear. Human vestibular reflexes are essential not only for gait and posture but also for goal-directed voluntary movements. In this study, cervical vestibular-evoked myogenic potentials (cVEMPs), the electrophysiological equivalent of the vestibulo-collic reflex was studied in ET patients to understand the interaction between the tremor network and the vestibular neural pathways. METHODS cVEMPs were recorded in 40 ET patients and 40 age and sex-matched healthy controls (HCs). The latencies of peaks p13 and n23 and peak-to-peak amplitude of p13-n23 were measured. RESULTS There was no statistically significant difference between the p13 latencies of the HC and ET groups (p 0.79 and p 0.23 for the right and left sides respectively). n23 latency was shortened bilaterally in the ET group (p 0.009 and p 0.02 for the right and left sides respectively). p13-n23 amplitudes of the ET patients were bilaterally reduced when compared with the HC (p <0.001 and p 0.001 for the right and left sides respectively). CONCLUSION Information provided by vestibular afferents is crucial in the control of voluntary movements in humans. Despite this silent but significant effect, the role of the vestibular system in movement disorders is often overlooked. In this study, it was found that cVEMP responses reflecting the activity of the vestibulo-collic pathway were affected in ET which can be either caused by dysfunctional structures or pathways responsible from ET or an additional disorder of vestibular information processing in these patients.
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Affiliation(s)
- Feray Gulec Uyaroglu
- Department of Neurology, Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Roza Ucar
- Department of Neurology, Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Ahmet Acarer
- Department of Neurology and Clinical Neurophysiology, Ege University Medical School, Bornova, 35100, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology and Clinical Neurophysiology, Ege University Medical School, Bornova, 35100, Izmir, Turkey.
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Alvarez TL, Scheiman M, Morales C, Gohel S, Sangoi A, Santos EM, Yaramothu C, d'Antonio-Bertagnolli JV, Li X, Biswal BB. Underlying neurological mechanisms associated with symptomatic convergence insufficiency. Sci Rep 2021; 11:6545. [PMID: 33753864 PMCID: PMC7985149 DOI: 10.1038/s41598-021-86171-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
Convergence insufficiency (CI) is the most common binocular vision problem, associated with blurred/double vision, headaches, and sore eyes that are exacerbated when doing prolonged near work, such as reading. The Convergence Insufficiency Neuro-mechanism Adult Population Study (NCT03593031) investigates the mechanistic neural differences between 50 binocularly normal controls (BNC) and 50 symptomatic CI participants by examining the fast and slow fusional disparity vergence systems. The fast fusional system is preprogrammed and is assessed with convergence peak velocity. The slow fusional system optimizes vergence effort and is assessed by measuring the phoria adaptation magnitude and rate. For the fast fusional system, significant differences are observed between the BNC and CI groups for convergence peak velocity, final position amplitude, and functional imaging activity within the secondary visual cortex, right cuneus, and oculomotor vermis. For the slow fusional system, the phoria adaptation magnitude and rate, and the medial cuneus functional activity, are significantly different between the groups. Significant correlations are observed between vergence peak velocity and right cuneus functional activity (p = 0.002) and the rate of phoria adaptation and medial cuneus functional activity (p = 0.02). These results map the brain-behavior of vergence. Future therapeutic interventions may consider implementing procedures that increase cuneus activity for this debilitating disorder.
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Affiliation(s)
- Tara L Alvarez
- Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA.
| | - Mitchell Scheiman
- Pennsylvania College of Optometry, Salus University, Philadelphia, PA, USA
| | - Cristian Morales
- Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - Suril Gohel
- Department of Health Informatics, Rutgers University School of Health Professions, Newark, NJ, USA
| | - Ayushi Sangoi
- Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - Elio M Santos
- Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - Chang Yaramothu
- Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | | | - Xiaobo Li
- Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
| | - Bharat B Biswal
- Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, USA
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Meng Q, Tan X, Jiang C, Xiong Y, Yan B, Zhang J. Tracking Eye Movements During Sleep in Mice. Front Neurosci 2021; 15:616760. [PMID: 33716648 PMCID: PMC7947631 DOI: 10.3389/fnins.2021.616760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/04/2021] [Indexed: 12/02/2022] Open
Abstract
Eye movement is not only for adjusting the visual field and maintaining the stability of visual information on the retina, but also provides an external manifestation of the cognitive status of the brain. Recent studies showed similarity in eye movement patterns between wakefulness and rapid eye movement (REM) sleep, indicating that the brain status of REM sleep likely resembles that of awake status. REM sleep in humans could be divided into phasic REM and tonic REM sleep according to the difference in eye movement frequencies. Mice are the most commonly used animal model for studying neuronal and molecular mechanisms underlying sleep. However, there was a lack of details for eye movement patterns during REM sleep, hence it remains unknown whether REM sleep can be further divided into different stages in mice. Here we developed a device combining electroencephalogram (EEG), electromyogram (EMG) as well as eye movements recording in mice to study the eye movement patterns during sleep. We implanted a magnet beneath the conjunctiva of eye and tracked eye movements using a magnetic sensor. The magnetic signals showed strong correlation with video-oculography in head-fixed mice, indicating that the magnetic signals reflect the direction and magnitude of eye movement. We also found that the magnet implanted beneath the conjunctiva exhibited good biocompatibility. Finally, we examined eye movement in sleep–wake cycle, and discriminated tonic REM and phasic REM according to the frequency of eye movements, finding that compared to tonic REM, phasic REM exhibited higher oscillation power at 0.50 Hz, and lower oscillation power at 1.50–7.25 Hz and 9.50–12.00 Hz. Our device allowed to simultaneously record EEG, EMG, and eye movements during sleep and wakefulness, providing a convenient and high temporal-spatial resolution tool for studying eye movements in sleep and other researches in mice.
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Affiliation(s)
- Qingshuo Meng
- Institutes of Brain Science, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xinrong Tan
- Institutes of Brain Science, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chengyong Jiang
- Institutes of Brain Science, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yanyu Xiong
- Institutes of Brain Science, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Biao Yan
- Institutes of Brain Science, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiayi Zhang
- Institutes of Brain Science, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, China
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30
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Paraneoplastic Progressive Downbeat Nystagmus, Ataxia and Sensorineural Hearing Loss due to the ANTI-Kelch-11 Protein Antibody. J Neuroophthalmol 2021; 41:261-265. [PMID: 33630775 DOI: 10.1097/wno.0000000000001194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABSTRACT A 45-year-old man with a history of testicular seminoma treated 8 years earlier presented with chronic progressive truncal and limb ataxia, progressive sensorineural hearing loss, and episodic vertigo. Eye movement and neuro-otology examinations showed localizing abnormalities to the bilateral cerebellar flocculus, vermis, and bilateral cerebellar hemispheres. Audiometric testing showed bilateral symmetric sensorineural hearing loss. There was a normal MRI of the brain. Cerebrospinal fluid (CSF) showed modest lymphocytic pleocytosis, and there was an elevated serum choriogonadotrophic hormone. An abdominal CT scan showed a solitary, large retroperitoneal lymph node, and histopathologic examination of the node biopsy showed granulomatous inflammation without microorganisms; eventually, immunohistochemical markers confirmed the diagnosis of metastatic seminoma. Although normal neuroimaging and inflammatory CSF reaction suggested a paraneoplastic etiology, the initial paraneoplastic antibody testing was negative. Subsequent investigation identified a positive kelch-11 protein antibody, thus confirming the paraneoplastic connection between the metastatic seminoma and the subacute neurologic-cochleovestibular syndrome.
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31
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Shinmei Y, Takahashi A, Nakamura K, Shinkai A, Tagawa Y, Chin S, Ishida S. Cerebrospinal fluid hypovolemia syndrome after a traffic accident with abnormal eye movements: A case report. Am J Ophthalmol Case Rep 2020; 20:100997. [PMID: 33313441 PMCID: PMC7720019 DOI: 10.1016/j.ajoc.2020.100997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/14/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose To describe a rare case of cerebrospinal fluid hypovolemia syndrome after a traffic accident with abnormal eye movements. Observations A 19-year-old man was referred to our clinic after being hit by a car five months ago while riding a bicycle. After the accident, he sometimes noticed oscillopsia, and had postural headaches and reading difficulties. His eye movement recording revealed square wave jerks during fixation and decreased pursuit gain during horizontal smooth pursuit. MR myelography detected cerebrospinal fluid leakage and the patient was diagnosed with cerebrospinal fluid hypovolemia. After undergoing epidural blood patch therapy, the leakage disappeared, and his postural headaches improved immediately. Square wave jerks and decreased pursuit gain improved, and his oscillopsia and reading difficulty also improved after therapy. Conclusions and importance A patient with cerebrospinal fluid hypovolemia presented with square wave jerks and decreased pursuit gain. Epidural blood patch therapy was effective for the symptoms. When treating patients with oscillopsia and postural headaches, we should consider the possibility of cerebrospinal fluid hypovolemia syndrome in the differential diagnosis.
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Affiliation(s)
- Yasuhiro Shinmei
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Japan
- Corresponding author. Department of Ophthalmology, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan.
| | | | - Kayoko Nakamura
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Akihiro Shinkai
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Yoshiaki Tagawa
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Shinki Chin
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Japan
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