Ocular Torsions and the Subjective Visual Vertical with Brainstem and Cerebellar Lesions in Multiple Sclerosis.

Abstract

Background: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system that makes a burden on patients and their families leading to disability especially in young patients. Acute or chronic lesions of MS within the brainstem and cerebellum frequently results in ocular motor disorders and deviation of subjective visual vertical (SVV). Aim: Finding a feasible, convenient way to evaluate ocular motor disorders in MS patients with brainstem and cerebellar affection and also to investigate to what extent they have problems with the estimation of verticality and also to demonstrate the relationship with stages of MS and expanded disability status scale (EDSS). Patients and Methods: Here, an observational case control study involving 95 patients: 65 patients with relapsing remitting multiple sclerosis all with brainstem and/or cerebellar affection and 30 healthy age and gender matched individual. MS patients were subjected to complete bedside evaluation, oculomotor testing and SVV testing while control group were subjected to subjective visual vertical evaluation. Results:The study found that MS patients with brainstem and/or cerebellar affection experienced variety of ocular motor disorders. SVV abnormalities were detected with both cerebellar and brainstem lesions. SVV showed a highly statistically significant difference in both groups. Conclusion: Clinical examination of eye movement and also SVV evaluation, takes only a few minutes to perform, but provide better information concerning the presence of brainstem and cerebellar involvement in MS patients.