Patterns of dissociate torsional–vertical nystagmus in internuclear ophthalmoplegia

Jeong, Seong-Hae; Kim, Eung Kyu; Lee, Jun; Choi, Kyeongdal; Kim, Ji Soo

doi:10.1111/j.1749-6632.2011.06155.x

Cited by 41 publications

(19 citation statements)

References 33 publications

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“…It is characterized by slowing of/or limited adduction during horizontal eye movements in the affected eye and dissociated abducting nystagmus in the intact eye ( 1 – 3 ). Besides these cardinal deficits, the vertical vestibulo-ocular reflex (VOR) can be impaired in INO since the MLF conveys VOR-signals from the vertical semicircular canals and the otolith organs ( 4 , 5 ). INO is often accompanied by a contraversive ocular tilt reaction (OTR) that is largely due to interruption of the graviceptive pathways from the contralateral utricle or the contralateral vertical semicircular canals, which ascend in the MLF after decussation in the lower pons ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Preferential Impairment of the Contralesional Posterior Semicircular Canal in Internuclear Ophthalmoplegia

Lee

Kim

et al. 2017

Front. Neurol.

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BackgroundThe vertical vestibulo-ocular reflex (VOR) may be impaired in internuclear ophthalmoplegia (INO) as the medial longitudinal fasciculus (MLF) conveys VOR-signals from the vertical semicircular canals. It has been proposed that signals from the contralesional posterior semicircular canal (PSC) are exclusively transmitted through the MLF, while for the contralesional anterior canal other pathways exist.ObjectiveHere, we aimed to characterize dysfunction in individual canals in INO-patients using the video-head-impulse test (vHIT) and to test the hypothesis of dissociated vertical canal impairment in INO.MethodsVideo-head-impulse testing and magnetic resonance imaging were obtained in 21 consecutive patients with unilateral (n = 16) or bilateral (n = 5) INO and 42 controls. VOR-gains and compensatory catch-up saccades were analyzed and the overall function (normal vs. impaired) of each semicircular canal was rated.ResultsIn unilateral INO, largest VOR-gain reductions were noted in the contralesional PSC (0.55 ± 0.11 vs. 0.89 ± 0.08, p < 0.001), while in bilateral INO both posterior (0.43 ± 0.11 vs. 0.89 ± 0.08, p < 0.001) and anterior (0.58 ± 0.19 vs. 0.88 ± 0.09, p < 0.001) canals showed marked drops. Small, but significant VOR-gain reductions were also found in the other canals in unilateral and bilateral INO-patients. Impairment of overall canal function was restricted to the contralesional posterior canal in 60% of unilateral INO-patients, while isolated involvement of the posterior canal was rare in bilateral INO-patients (20%). Reviewers correctly identified the INO-pattern in 15/21 (71%) patients and in all controls (sensitivity = 84.2% [95%-CI = 0.59.5–95.8]; specificity = 95.5% [95%-CI = 83.3–99.2]).ConclusionUsing a vHIT based overall rating of canal function, the correct INO-pattern could be identified with high accuracy. The predominant and often selective impairment of the contralesional posterior canal in unilateral INO further supports the role of the MLF in transmitting posterior canal signals. In patients with acute dizziness and abnormal vHIT-results, central pathologies such as INO should be considered as well, especially when the posterior canal is involved.

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Section: Introductionmentioning

confidence: 99%

Preferential Impairment of the Contralesional Posterior Semicircular Canal in Internuclear Ophthalmoplegia

Lee

Kim

et al. 2017

Front. Neurol.

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“…The patterns of jerky seesaw nystagmus in internuclear ophthalmoplegia suggests a disruption of neural pathways from the contralateral vertical semicircular canals with or without concomitant damage to the fibers from the contralateral utricle in or near the medial longitudinal fasciculus. 22 Both seesaw nystagmus and dissociated vertical divergence are cyclovertical eye movements characterized by vertical disconjugation and torsional conjugation. Seesaw nystagmus is known to occur with chiasmal disorders and an associated bitemporal hemianopsia.…”

Section: Head-shaking Nystagmus In Cerebellar Infarctionmentioning

confidence: 99%

Neuro-ophthalmology Annual Review

Al‐Zubidi¹,

Spitze²,

Yalamanchili³

et al. 2013

Asia-Pacific Journal of Ophthalmology

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“…There may be other associated signs including an ocular tilt reaction (discussed in detail below) and subtle spontaneous vertical-torsional nystagmus. 45 Skew deviation is the other central cause of diplopia discussed briefly above, and can result from lesions within the posterior fossa interrupting connections between the utricle and ocular motor nuclei. An imbalance in the utricle-ocular motor pathways along their course from labyrinth to the interstitial nucleus of Cajal of the midbrain may result in a distorted perception of earth-vertical (referred to as the subjective visual vertical), skew deviation, head tilt, and conjugate ocular torsion or counterroll toward the side of the hypotropic eye.…”

Section: Diplopiamentioning

confidence: 99%

Acute Visual Disorders—What Should the Neurologist Know?

Brune

Gold

2019

Semin Neurol

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Normal vision requires coordination of precisely controlled and coordinated eye movements and normal function of a large cortical and subcortical sensory network. Given the required precision of the system and wide anatomic distribution of the motor and sensory visual systems, vision can be disrupted by a variety of central and peripheral nervous system disorders. While many of these may be relatively benign or have no proven therapy, several may be isolated presentations or harbingers of more serious neurologic conditions. Both monocular and binocular vision losses may be isolated presentations of stroke or its equivalent. Other etiologies of monocular vision loss may represent the initial presentation of potentially disabling conditions. Binocular diplopia, caused by impaired movement of one or both eyes, may represent a condition with no acute therapy and a benign natural history, or a progressive potentially life-threatening syndrome. Most people are heavily reliant upon vision, so that even a subtle change in vision due to disturbed afferent or efferent pathways is invariably noticed, and presentation to the emergency department for eye symptoms is common. The accurate evaluation of these patients in the acute setting is essential to identify the patients requiring immediate testing or treatment.

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Patterns of dissociate torsional–vertical nystagmus in internuclear ophthalmoplegia

Cited by 41 publications

References 33 publications

Preferential Impairment of the Contralesional Posterior Semicircular Canal in Internuclear Ophthalmoplegia

Preferential Impairment of the Contralesional Posterior Semicircular Canal in Internuclear Ophthalmoplegia

Neuro-ophthalmology Annual Review

Acute Visual Disorders—What Should the Neurologist Know?

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