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Ewe R, White OB, Burke A. Isolated Horizontal Gaze Palsy: Observations and Explanations. Front Neurol 2017; 8:611. [PMID: 29187832 PMCID: PMC5694745 DOI: 10.3389/fneur.2017.00611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 11/02/2017] [Indexed: 12/30/2022] Open
Abstract
We present three cases that we suggest require a novel diagnosis and a reconsideration of current understandings of pontine anatomy. In this case series, we highlight a series of patients with monophasic, fully recovering inflammatory lesions in the pontine tegmentum not due to any of the currently recognized causes of this syndrome. We highlight other similar cases in the literature and suggest there may be a particular epitope for an as-yet-undiscovered antibody underlying the tropism for this area. We highlight the potential harm of misdiagnosis with relapsing inflammatory or other serious diagnoses with significant adverse impact on the patient. In addition, we propose that this would support a reinterpretation of the currently accepted anatomy of the pontine gaze inputs to the median longitudinal fasciculus and paramedian pontine reticular formation.
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Affiliation(s)
- Renee Ewe
- Whittington Hospital, London, United Kingdom
| | - Owen B White
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Ailbhe Burke
- The National Hospital for Nervous Diseases, London, United Kingdom
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2
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Xue F, Zhang L, Zhang L, Ying Z, Sha O, Ding Y. One-and-a-half syndrome with its spectrum disorders. Quant Imaging Med Surg 2017; 7:691-697. [PMID: 29312874 DOI: 10.21037/qims.2017.12.04] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
One-and-a-half syndrome is a syndrome characterized by horizontal movement disorders of the eyeballs, which was first reported and named by Fisher in 1967. It presents a combination of ipsilateral conjugate horizontal gaze palsy (one) and ipsilateral internuclear ophthalmoplegia (INO) (a half). On the basis of the one-and-a-half syndrome, there are a series of related rare syndromes called the one-and-a-half syndrome spectrum disorders. This article reviews rare cases of one-and-a-half syndrome spectrum disorder, describes the clinical and pathological features of different syndromes, and summarizes their nomenclature.
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Affiliation(s)
- Fang Xue
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Lihong Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Li Zhang
- Department of Physiology and Neurology, University of Connecticut, Storrs, USA
| | - Zhenguang Ying
- Department of Anatomy, Histology and Developmental Biology, School of Basic Medical Sciences, Shenzhen University, Shenzhen 518060, China
| | - Ou Sha
- Department of Anatomy, Histology and Developmental Biology, School of Basic Medical Sciences, Shenzhen University, Shenzhen 518060, China
| | - Yan Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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3
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Lloyd-Smith Sequeira A, Rizzo JR, Rucker JC. Clinical Approach to Supranuclear Brainstem Saccadic Gaze Palsies. Front Neurol 2017; 8:429. [PMID: 28878733 PMCID: PMC5572401 DOI: 10.3389/fneur.2017.00429] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 08/08/2017] [Indexed: 12/14/2022] Open
Abstract
Failure of brainstem supranuclear centers for saccadic eye movements results in the clinical presence of a brainstem-mediated supranuclear saccadic gaze palsy (SGP), which is manifested as slowing of saccades with or without range of motion limitation of eye movements and as loss of quick phases of optokinetic nystagmus. Limitation in the range of motion of eye movements is typically worse with saccades than with smooth pursuit and is overcome with vestibular–ocular reflexive eye movements. The differential diagnosis of SGPs is broad, although acute-onset SGP is most often from brainstem infarction and chronic vertical SGP is most commonly caused by the neurodegenerative condition progressive supranuclear palsy. In this review, we discuss the brainstem anatomy and physiology of the brainstem saccade-generating network; we discuss the clinical features of SGPs, with an emphasis on insights from quantitative ocular motor recordings; and we consider the broad differential diagnosis of SGPs.
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Affiliation(s)
| | - John-Ross Rizzo
- Department of Neurology, New York University School of Medicine, New York, NY, United States.,Department of Physical Medicine and Rehabilitation, New York University School of Medicine, New York, NY, United States
| | - Janet C Rucker
- Department of Neurology, New York University School of Medicine, New York, NY, United States.,Department of Ophthalmology, New York University School of Medicine, New York, NY, United States
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4
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Abstract
Adult onset, multiple oculo-motor nerve palsies are usually due to neoplasia and trauma. We report two cases whose initial presenting sign was oculo-motor cranial nerve palsy and were later found to have metastatic carcinoma.
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Affiliation(s)
- D Kumudhan
- Department of ophthalmology, Queen Margaret Hospital, Dunfermline, Scotland.
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5
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Kipfer S, Crook DW. Isolated bilateral horizontal gaze palsy as first manifestation of multiple sclerosis. Mult Scler 2014; 20:754-5. [DOI: 10.1177/1352458513518627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Predilection sites for infratentorial multiple sclerosis lesions are well known and frequently involve the fasciculus longitudinalis medialis leading to classical internuclear ophthalmoplegia. We report a very rare oculomotor disorder due to a demyelinating central nervous system (CNS) lesion in the medial part of the lower pontine tegmentum. A 36-year-old man presented with sudden onset of blurred vision. Clinically there was limited eye adduction and abduction to either side, which corresponds to bilateral horizontal gaze palsy. Brain magnetic resonance imaging (MRI) showed a demyelinating CNS lesion affecting the fasciculus longitudinalis medialis, abducens nuclei or abducens fibres in the medial part of the lower pontine tegmentum. Furthermore there were six further demyelinating white matter lesions fulfilling all Barkhof criteria for multiple sclerosis. Demyelinating CNS lesions causing isolated bilateral horizontal gaze palsy are exceptional and usually associated with further focal neurological deficits, which was not the case in the presenting patient. This is a unique video report of isolated bilateral horizontal gaze palsy as the initial manifestation of demyelinating CNS disease, which lead to definite diagnosis of relapsing remitting multiple sclerosis.
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Affiliation(s)
- Stefan Kipfer
- Department of Internal Medicine and Neurology, Kantonsspital Olten, Switzerland
| | - David W Crook
- Department of Radiology, Kantonsspital Olten, Switzerland
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Bae YJ, Kim JH, Choi BS, Jung C, Kim E. Brainstem pathways for horizontal eye movement: pathologic correlation with MR imaging. Radiographics 2013; 33:47-59. [PMID: 23322826 DOI: 10.1148/rg.331125033] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Horizontal eye movements are conducted by the medial rectus and the lateral rectus muscles, which are innervated by the oculomotor nerve (cranial nerve III) and the abducens nerve (cranial nerve VI), respectively. The oculomotor and the abducens nuclei are interconnected by a tract in the brainstem named the medial longitudinal fasciculus (MLF). Through the MLF, the actions of the oculomotor and the abducens nuclei are coordinated, generating conjugate horizontal eye movements. The disorders of horizontal eye movement that are caused by brainstem lesions are classified into three groups: (a) lateral gaze palsy, (b) internuclear ophthalmoplegia, and (c) one-and-a-half syndrome. Lateral gaze palsy is caused by a lesion involving the paramedian pontine reticular formation (PPRF) or the abducens nucleus. Internuclear ophthalmoplegia occurs as a result of a lesion involving the MLF. One-and-a-half syndrome is a combination of lateral gaze palsy and internuclear ophthalmoplegia and is caused by a lesion involving both (a) the ipsilateral PPRF or the ipsilateral abducens nucleus and (b) the ipsilateral MLF. The pathologic lesions depicted on magnetic resonance images were topographically well correlated with the brainstem pathways and each type of horizontal eye movement disorder. Most of the lesions were tiny acute infarctions and were found in the most posterior region of the pons, which corresponded to the location of the brainstem pathways. Therefore, awareness of the brainstem pathways controlling horizontal eye movement is important to avoid missing a small pontine lesion.
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Affiliation(s)
- Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 436-707, Korea
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Tsuda H, Kageyama SI, Tanaka K, Miura Y, Kishida S. Bilateral Horizontal Gaze Paresis as an Initial Manifestation of Wernicke Encephalopathy. Neuroophthalmology 2012. [DOI: 10.3109/01658107.2012.686145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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8
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Abstract
Accurate diagnosis of abnormal eye movements depends upon knowledge of the purpose, properties, and neural substrate of distinct functional classes of eye movement. Here, we summarize current concepts of the anatomy of eye movement control. Our approach is bottom-up, starting with the extraocular muscles and their innervation by the cranial nerves. Second, we summarize the neural circuits in the pons underlying horizontal gaze control, and the midbrain connections that coordinate vertical and torsional movements. Third, the role of the cerebellum in governing and optimizing eye movements is presented. Fourth, each area of cerebral cortex contributing to eye movements is discussed. Last, descending projections from cerebral cortex, including basal ganglionic circuits that govern different components of gaze, and the superior colliculus, are summarized. At each stage of this review, the anatomical scheme is used to predict the effects of lesions on the control of eye movements, providing clinical-anatomical correlation.
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Nuclear, internuclear, and supranuclear ocular motor disorders. HANDBOOK OF CLINICAL NEUROLOGY 2011; 102:319-31. [PMID: 21601072 DOI: 10.1016/b978-0-444-52903-9.00018-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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10
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Han SB, Kim JH, Hwang JM. Presumed metastasis of breast cancer to the abducens nucleus presenting as gaze palsy. KOREAN JOURNAL OF OPHTHALMOLOGY 2010; 24:186-8. [PMID: 20532149 PMCID: PMC2882086 DOI: 10.3341/kjo.2010.24.3.186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 04/23/2010] [Indexed: 11/23/2022] Open
Abstract
A 51-year-old woman with breast cancer presented with progressive diplopia. Neuro-ophthalmologic examination revealed right gaze palsy and peripheral facial nerve palsy. Brain magnetic resonance imaging (MRI) was normal. However, two months later a repeat brain MRI revealed an enhancing round nodular mass at the right facial colliculus of the lower pons, at the location of the abducens nucleus. Localized metastasis to the abducens nucleus can cause gaze palsy in a patient with breast cancer.
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Affiliation(s)
- Sang Beom Han
- Department of Ophthalmology, Seoul National University Bundang Hospital, #300 Gumi-dong, Bundang-gu, Seongnam, Korea
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11
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Liu GT, Volpe NJ, Galetta SL. Eye movement disorders. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00016-0] [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] Open
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12
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Verhagen WIM, Huygen PLM, Schulte BPM. Ocular motor responses after locked-in syndrome: Sparing of subcortical optokinetic nystagmus? Neuroophthalmology 2009. [DOI: 10.3109/01658108709007427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Pierrot-Deseilligny C, Rivaud S, Samson Y, Cambon H. Some instructive cases concerning the circuitry of ocular smooth pursuit in the brainstem. Neuroophthalmology 2009. [DOI: 10.3109/01658108909019505] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Pontine gaze deviation and face turn relieved by eye muscle surgery. J Neuroophthalmol 2008; 28:104-6. [PMID: 18562840 DOI: 10.1097/wno.0b013e31817726fa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 34-year-old woman developed a bilateral horizontal gaze palsy, left gaze deviation, and right face turn consequent to a pontine hemorrhage. A bilateral horizontal recession and resection of extraocular muscles in both eyes (Parks procedure) eliminated the gaze deviation and face turn. This is the first reported case in which this procedure was used to correct a face turn in a patient with bilateral horizontal gaze palsy but without ocular misalignment.
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Steffen H. [Diagnosis of supranuclear eye movement disorders. Part I: different types of eye movements]. Ophthalmologe 2007; 103:901-9, quiz 910-1. [PMID: 16988844 DOI: 10.1007/s00347-006-1420-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The hallmark of a supranuclear eye movement disorder is a functional impairment of one or several types of different eye movements while other types of eye movements still work. All eye movement information is conveyed via the nuclei of the eye muscle nerves. However, the information for a specific type of eye movement is generated in prenuclear cortical and subcortical areas which are activated depending on the type of eye movement performed. Knowledge about the anatomy of these areas enables us to make a clinical diagnosis or to localize the pathological process to a specific area in many neurological conditions. Examination of eye movements are thus a valuable clinical tool in many neurological and neuroophthalmological diseases. The first part of this two-part contribution presents the different types of eye movements, the concept of neural integration, and prenuclear structures important for horizontal eye movement as well as the pertinent pathology. The second part will appear in the next issue and deals with the cerebral structures that are relevant for vertical eye movements including their pathology.
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Affiliation(s)
- H Steffen
- Schielbehandlung und Neuroophthalmologie, Universitätsaugenklinik und Poliklinik, Josef Schneider-Strasse 11, 97080 Würzburg, Germany.
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Vara-Castrodeza A, Torrego-García JC, Puertas-Alvarez JL, Mendo-González M. Pontine metastases as a cause of dysphagia in lung carcinoma. Clin Transl Oncol 2005; 7:512-4. [PMID: 16373063 DOI: 10.1007/bf02717005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dysphagia is an unusual symptom in the clinical course of lung carcinoma. When it appears, it is necessary to differentiate between regional dissemination, drug toxicity, opportunistic infection and, most rarely, metastatic dissemination to the brain stem. Magnetic resonance imaging (MRI) is the best diagnostic option to exclude this last possibility. We present a male patient with progressive dysphagia 15 months after the diagnosis of an oat-cell lung carcinoma. Cerebral MRI revealed a pontine lesion, probably of metastatic origin.
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Tsutsumi S, Horinaka N, Mori K, Maeda M. Metastatic brainstem tumor manifesting as hearing disturbance--case report. Neurol Med Chir (Tokyo) 2001; 41:561-4. [PMID: 11758711 DOI: 10.2176/nmc.41.561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 53-year-old male, who had undergone a left upper lung lobectomy for cancer 2 years previously, presented with metastatic brainstem tumor manifesting as hearing disturbance. At first an otorhinolaryngologist treated him for senile sensorineural hearing disturbance. However, he suffered gait ataxia and was referred to our department. On admission, neurological examination found mild cerebellar ataxia on the left and gait unsteadiness. Neurootological analysis revealed central-type sensorineural hearing disturbance on the left both in the pure tone audiogram and speech discrimination test. Neuroimaging studies revealed a ring-like enhanced mass centered in the ventral left middle cerebellar peduncle, partly extending to the inferior cerebellar peduncle. Peritumoral edema extending to the ipsilateral cochlear nucleus was recognized. He underwent surgery via a left lateral suboccipital transcondylar approach. The histological diagnosis was adenocarcinoma identical with the primary lung cancer. Intra-axial brainstem metastatic lesion can be a cause of hearing disturbance, so should be included in the differential diagnosis for a patient complaining of hearing disturbance, especially with a past history of cancer.
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Affiliation(s)
- S Tsutsumi
- Department of Neurosurgery, Juntendo University Izunagaoka Hospital, Shizuoka, Japan
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18
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Affiliation(s)
- D M Squirrell
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Cassidy L, Taylor D, Harris C. Abnormal supranuclear eye movements in the child: a practical guide to examination and interpretation. Surv Ophthalmol 2000; 44:479-506. [PMID: 10906380 DOI: 10.1016/s0039-6257(00)00114-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abnormal eye movements in the infant or voting child can be congenital or acquired. They may be a result of abnormal early visual development or a sign of underlying neurologic or neuromuscular disease. It is important to be able to detect these abnormalities and to distinguish them from normal but immature eye movements. The spectrum of disease in children differs from that in adults. Serious, potentially fatal but treatable disorders can be acquired in infancy, and abnormal eye movements in a sometimes apparently well child should never be labeled as congenital or benign without careful investigation. Eye movement analysis can indicate the presence of an underlying condition and help the clinician to classify different neurologic diseases. It is important to carefully examine the ocular motor system in any children at risk of neurologic disease. This review provides a practical guide to the examination and interpretation of eye movements in the child and includes recent literature on eye movement disorders of childhood. We describe supranuclear abnormalities of the ocular motor system in the order in which we would normally examine it: saccades, pursuit, convergence, vestibulo-ocular reflex, and optokinetic nystagmus. Nystagmus, internuclear ophthalmoplegia, cranial nerve abnormalities, and "miswiring" phenomena (such as Duane's syndrome and synergistic divergence) are not discussed.
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Affiliation(s)
- L Cassidy
- Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom
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Moschovakis AK. Neural network simulations of the primate oculomotor system. II. Frames of reference. Brain Res Bull 1996; 40:337-43; discussion 344-5. [PMID: 8886356 DOI: 10.1016/0361-9230(96)00124-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Theories of motor control often assume that the location of visual stimuli is expressed in non retinotopic frames of reference. The saccadic system is known in enough detail for us to examine the evidential basis of this assumption. The organization of the neural circuit that controls saccades is first summarized. It is shown to consist of at least two interconnected modules. The first one is the burst generator, which resides in the reticular formation, and is entrusted with the tasks of impedance matching, synergist coactivation and reciprocal inhibition between antagonists. The second is a metric computer, which resides in the superior colliculus and the cerebral cortex, and computes the size and direction of the desired movement. Alternative models of the burst generator are presented and their "verisimilitude" is assessed in the light of evidence concerning saccadic trajectories, neuronal discharge patterns, interneuronal connections, as well as the results of lesion and stimulation experiments. Several models of the "metric computer" in the superior colliculus are then examined; their performance is again evaluated in the light of psychophysical, anatomical, physiological, and clinical evidence. It is demonstrated that the location of visual stimuli need not be expressed in nonretinotopic frames of reference for either the burst generator or the metric computer to issue appropriate commands to move the eyes. Instead, using information concerning intervening movements of the eyes to update the location of visual stimuli in a retinotopic frame of reference suffices for the planning and execution of correct saccades. More generally, it is proposed that the location of sensory stimuli need not be expressed in higher order frames of reference (e.g., centered in the body or even in extrapersonal space) provided that their location in a sensorium specific map is updated on the basis of effector movements.
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Affiliation(s)
- A K Moschovakis
- Department of Basic Sciences, Faculty of Medicine, School of Health Sciences, University of Crete, Greece
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Johnston JL, Sharpe JA, Morrow MJ. Paresis of contralateral smooth pursuit and normal vestibular smooth eye movements after unilateral brainstem lesions. Ann Neurol 1992; 31:495-502. [PMID: 1596085 DOI: 10.1002/ana.410310506] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pursuit and vestibular smooth eye movements were measured in patients with lesions of the caudal brainstem tegmentum identified by magnetic resonance imaging (MRI) and computed tomography (CT), with neuropathological correlation in 1 patient. Contralateral smooth pursuit gain was significantly lower than ipsilateral gain in each patient. Ipsilateral smooth pursuit gain was also subnormal in patients with unilateral pontine damage that caused slowing of ipsilateral saccades. Horizontal vestibulo-ocular reflex gain and phase were normal. These quantitative correlations indicate that lesions of the pontine tegmentum that paralyze ipsilateral saccades can spare the vestibulo-ocular reflex, and that smooth pursuit movement and the vestibulo-ocular reflex can be impaired independently by pontine or medullary lesions. In contrast to lesions at other sites, unilateral lesions of the pontine or medullary tegmentum impair contralateral smooth pursuit more than ipsilateral pursuit movements. These findings provide evidence that a double decussating pathway mediates smooth pursuit; the first decussation is from the pons to the cerebellum, and the second decussation is from the vestibular nucleus to the contralateral abducens nucleus.
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Affiliation(s)
- J L Johnston
- Neuro-Ophthalmology Unit, Toronto Hospital Neurological Centre, Ontario, Canada
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22
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Müllges W, Ferbert A. Congenital bilateral horizontal gaze palsy in two adult patients. Neuroophthalmology 1992. [DOI: 10.3109/01658109209058126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fontanari JL, Vaitses VD, Cruz CE, Tichauer TA, Lisboa L, Souza ES. [Combined lateral gaze palsy with unilateral internuclear ophthalmoplegia in high mesencephalic-pontine hemorrhage. Report of a case]. ARQUIVOS DE NEURO-PSIQUIATRIA 1986; 44:383-90. [PMID: 3606431 DOI: 10.1590/s0004-282x1986000400009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The authors report a case of right midbrain and high pons haemorrhage with complete external ophthalmoplegia, except bilateral convergence, voluntary and automatic-reflex abduction of the left eye and adduction of this eye with vestibulo-ocular reflex ("one-and-a-half syndrome"). There is voluntary-automatic dissociation of the eyelids motricity and the vertical gaze. Still, there is sensitive-motor hemiplegia at left and asterixis.
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Slavin ML. A clinicoradiographic correlation of bilateral horizontal gaze palsy and slowed vertical saccades with midline dorsal pontine lesion on magnetic resonance imaging. Am J Ophthalmol 1986; 101:118-20. [PMID: 3942166 DOI: 10.1016/0002-9394(86)90479-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Koehler PJ, Wattendorff AR, Goor C, Hekster RE, Falke TH. Bilateral horizontal gaze paralysis due to pontine hemorrhage. A case report. Clin Neurol Neurosurg 1986; 88:121-5. [PMID: 3757383 DOI: 10.1016/s0303-8467(86)80007-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In a case of bilateral horizontal gaze paralysis, vertical gaze was clinically intact but eye movement recordings demonstrated a transient reduction of vertical saccadic velocities. Horizontal caloric vestibulo-ocular responses were absent. CT scanning and NMR imaging showed a hematoma in the median pontine tegmentum. This case provides additional evidence that vertical and horizontal saccade genesis may be independent of caudal paramedian pontine reticular formation lesions.
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Dehaene I, Dom R, Marchau M, Geens K. Locked-in syndrome with bilateral ptosis: combination of bilateral horizontal pontine gaze paralysis and nuclear oculomotor nerve paralysis. J Neurol 1985; 232:366-7. [PMID: 4078603 DOI: 10.1007/bf00313838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A patient with a classical locked-in syndrome is described, in whom bilateral ptosis was observed on the 2nd day. On the 4th day, ophthalmoplegia was complete with the exception of a voluntary downward movement of the right eye. The syndrome can be explained by the association of bilateral horizontal pontine gaze palsy and a unilateral nuclear oculomotor nerve palsy, and approximates the "total locked-in syndrome".
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Abstract
Despite the complete absence of horizontal saccades, two patients with pontine gliomas had horizontal reflex eye movements within a range of +/- 20 degrees. The gain (peak eye velocity/peak stimulus velocity) and phase of the vestibulo-ocular reflex were normal, but the optokinetic gain was decreased. The latency, accuracy, and peak velocity of vertical saccades were normal. Apparently the voluntary gaze centers in the pontine reticular formation are not crucial for generating horizontal vestibular or vertical saccadic eye movements.
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