Paroxysmal ocular tilt reactions after mesodiencephalic lesions: Report of two cases and review of the literature

Oh, Sun-Young; Choi, Kwang-Dong; Shin, Byoung‐Soo; Seo, Man-Wook; Kim, Young Hyun; Kim, Ji Soo

doi:10.1016/j.jns.2008.10.023

Cited by 9 publications

(5 citation statements)

References 18 publications

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“…In our case, it is reasoned that a gradual excitation of projections to the INC can explain the current-dependent OTR ipsilateral to DBS, while contralateral torsional nystagmus at higher currents speaks for additional activation of integrator neurons directly in the INC [4,5]. Importantly, these findings closely correspond to reports of paroxysmal ipsiversive OTR hypothesized to originate from irritative effects of mesodiencephalic lesions on INC and/or rostral interstitial nucleus of the MLF (riMLF) neurons [10,11].…”

Section: Discussionsupporting

confidence: 85%

“…In our case, it is reasoned that a gradual excitation of projections to the INC can explain the current‐dependent OTR ipsilateral to DBS, while contralateral torsional nystagmus at higher currents speaks for additional activation of integrator neurons directly in the INC [4,5]. Importantly, these findings closely correspond to reports of paroxysmal ipsiversive OTR hypothesized to originate from irritative effects of mesodiencephalic lesions on INC and/or rostral interstitial nucleus of the MLF (riMLF) neurons [10,11]. To the best of our knowledge, this case is the first to recapitulate a lesional eye movement disorder in a reversible manner by means of electrical stimulation, thereby corroborating abnormal excitation of the INC as a pathomechanistic underpinning of ipsiversive OTR.…”

Section: Discussionsupporting

confidence: 75%

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Current‐dependent ocular tilt reaction in deep brain stimulation of the subthalamic nucleus: Evidence for an incerto‐interstitial pathway?

Friedrich

Eldebakey

Roothans

et al. 2022

Euro J of Neurology

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Background and purpose: The aim was to characterize a combined vestibular, ocular motor and postural syndrome induced by deep brain stimulation (DBS) of the subthalamic nucleus in a patient with Parkinson's disease. Methods: In a systematic DBS programming session, eye, head and trunk position in roll and pitch plane were documented as a function of stimulation amplitude and field direction. Repeat ocular coherence tomography was used to estimate ocular torsion. The interstitial nucleus of Cajal (INC), zona incerta (ZI) and ascending vestibular fibre tracts were segmented on magnetic resonance imaging using both individual and normative structural connectomic data. Thresholded symptom-associated volumes of tissue activated (VTA) were calculated based on documented stimulation parameters. Results: Ipsilateral ocular tilt reaction and body lateropulsion as well as contralateral torsional nystagmus were elicited by the right electrode in a current-dependent manner and subsided after DBS deactivation. With increasing currents, binocular tonic upgaze and body retropulsion were observed. Symptoms were consistent with an irritative effect on the INC. Symptom-associated VTA was found to overlap with the dorsal ZI and the ipsilateral vestibulothalamic tract, while lying rather distant to the INC proper. A ZI-to-INC 'incerto-interstitial' tract with contact to the medial-uppermost portion of the VTA could be traced. Conclusion: Unilateral stimulation of INC-related circuitry induces an ipsilateral vestibular, ocular motor and postural roll-plane syndrome, which converts into a pitch-plane syndrome when functional activation expands bilaterally. In this case, tractography points to an incerto-interstitial pathway, a tract previously only characterized in non-human primates. Directional current steering proved useful in managing this rare side effect.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 75%

Current‐dependent ocular tilt reaction in deep brain stimulation of the subthalamic nucleus: Evidence for an incerto‐interstitial pathway?

Friedrich

Eldebakey

Roothans

et al. 2022

Euro J of Neurology

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“…Further, photography interferes with binocular fusion and may, therefore, bring forth otherwise latent cyclophorias. Finally, any short‐term variations in torsions akin to those occurring in overt paroxysmal ocular tilt reactions may contribute to more variation in photographs than in the subjective test unless right and left photographs are obtained at identical positions in the cycle. The same problem applies to any coexisting rotatory nystagmus.…”

Section: Discussionmentioning

confidence: 99%

Ocular torsions and the subjective visual vertical with central vestibulo-ocular system lesions: independence disproved

Frisén

2012

Acta Neurol Scand

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“…1,4,5 Some clinical reports showed that the patients who have thalamic vascular accident were tilted their head to contralateral side, complained of double visions and they have bilateral abnormal cycloduction in both eyes. 6,7 In their cases the thalamic lesion was large, so it might influence the INC where existed in the midbrain. In previous clinical reports, abnormal cycloduction is stronger than an affected side at an unaffected side.…”

Section: Discussionmentioning

confidence: 99%

Gait Balance Disorder by Thalamic Infarction with the Disorder of Interstitial Nucleus of Cajal

Kurosu

Hayashi

Wada

et al. 2011

Clin Med Insights Case Rep

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The interstitial nucleus of Cajal (INC) is thought to play an important role in torsional/vertical eye position and head posture, and disorders of the INC induce abnormal ocular movements and head tilt. Our patients with ocular tilt reactions simultaneously also had disturbances in ambulatory balance, yet no reports address the loss of balance control induced by disorders of the INC. We examined the ambulatory disturbances induced by INC lesion. We experienced three patients with ocular movement disorders and abnormal head tilt due to thalamic infarction. We performed ophthalmic examinations on and checked the balance of them. With funduscopy, abnormal cycloduction was seen in the unaffected side and normal cycloduction was observed in the affected side. Nevertheless, Hess charts showed distortions in the visual image of both eyes. They all had disorders of balance control. We tried to treat them using the Bobath approach for improving their ambulatory balance. With subsequent improvements in balance control it was possible for them to take short walks, but it was difficult to make any improvements in their ocular movement. The INC is related to balance control of ambulation and disorders of the INC induce ambulatory disturbances. Cycloduction was only observed in the unaffected side, but Hess charts showed distortions of the visual image in both eyes. Ambulation was briefly improved, but diplopia persisted in these patients.

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Paroxysmal ocular tilt reactions after mesodiencephalic lesions: Report of two cases and review of the literature

Cited by 9 publications

References 18 publications

Current‐dependent ocular tilt reaction in deep brain stimulation of the subthalamic nucleus: Evidence for an incerto‐interstitial pathway?

Current‐dependent ocular tilt reaction in deep brain stimulation of the subthalamic nucleus: Evidence for an incerto‐interstitial pathway?

Ocular torsions and the subjective visual vertical with central vestibulo-ocular system lesions: independence disproved

Gait Balance Disorder by Thalamic Infarction with the Disorder of Interstitial Nucleus of Cajal

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