Representation of the extra‐ocular muscles in the oculomotor nuclei of the monkey

Warwick, R.

doi:10.1002/cne.900980305

Cited by 265 publications

(63 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A more midline lesion involving just the central caudal nucleus results in bilateral ptosis with no limitation in ocular movement. A slightly more rostral lesion would involve the Edinger-Westphal nucleus leading to pupillary involvement while sparing the ocular motility muscles 9 (figures 1C and 2B, figure e-1, and table e-1) Another important localizing sign to observe is that unilaterally dilated pupil would indicate that the lesion is fascicular rather than nuclear. This is because the Edinger-Westphal nucleus is in the midline and causes bilateral mydriasis.…”

Section: Oy-stersmentioning

confidence: 99%

“…More laterally, the medial rectus, inferior rectus, and inferior oblique subnuclei are paired structures (lateral ventral, lateral intermediate, and lateral dorsal subnuclei, respectively) that innervate their corresponding ipsilateral muscles. 9 The superior rectus subnuclei or medial subnuclei are paired structures and innervate the respective contralateral superior rectus. Isolated lesions will spare the Figure 1 (A, B) MRI brain in axial and sagittal cuts with diffusion-weighted restriction show the infarct at the midbrain, rostral extension (arrows); and (C) schematic representation of oculomotor nuclear complex and perinuclear structures in the midbrain e196 Neurology 86 May 3, 2016 ipsilateral, and affect the contralateral, superior rectus.…”

Section: Oy-stersmentioning

confidence: 99%

See 1 more Smart Citation

Pearls & Oy-sters: Looking up the anatomy of looking up

et al. 2016

View full text Add to dashboard Cite

PEARLS1. A unilaterally dilated pupil would indicate that the lesion is fascicular rather than nuclear as the Edinger-Westphal nucleus is in the midline and causes bilateral mydriasis. 2. The inferior rectus, medial rectus, and inferior oblique muscles are supplied ipsilaterally while the superior rectus is supplied contralaterally. A 46-year-old Chinese man with diabetes mellitus, hypertension, and hyperlipidemia, developed sudden onset of vertiginous dizziness and diplopia that was worse on looking up. His symptoms were not preceded by any antecedent infections, neither was there any headache. Blood pressure on arrival in the Emergency Department was 145/95 mm Hg and his neurologic examination revealed bilateral upward gaze restriction (video on the Neurology ® Web site at Neurology.org). There was voluntary lid retraction by the patient. The pupils were 3 mm bilaterally and reactive to light and accommodation, there was no ptosis or nystagmus, and no fatigability could be elicited. Apart from esophoria and pseudo-6th nerve palsy, the rest of the eye movements were normal. Other cranial nerves, motor, sensory, and cerebellar examinations were unremarkable. The vertical optokinetic reflex was intact and there was no tremor of the upper limbs. On forced eye closure, there was upward deviation of his eyes consistent with the Bell phenomenon. ECG did not show any atrial fibrillation or ischemic changes. The basic blood investigations were unremarkable. He was initially diagnosed with myasthenia gravis with frontalis overactivity and complex ophthalmoplegia by the admitting emergency physicians.MRI revealed a lesion in the anterior periaqueductal midbrain, eccentrically situated to the left of the midline. The apparent diffusion coefficient characteristics were in keeping with an acute infarct (figure 1, A and B) and magnetic resonance angiogram did not reveal any stenosis. The patient was treated with aspirin, statins, and tight blood pressure control. DISCUSSION In our patient, abduction, adduction, downgaze, and convergence were preserved, and there was no ptosis, indicating that the respective subnuclei were spared. Apart from esophoria and a pseudo-6th nerve palsy, the only findings were asymmetric upgaze restriction and lid retraction ( figure 2A and video). This can be explained by the infarct in the caudal midline region in the posterior commissure location (figures 1C and 2B), which provides regulation to the respective superior rectus subnucleus.A review of the spatial anatomy of the subnuclei components of the oculomotor complex and its surrounding structures would be useful in understanding this clinical presentation and that of other midbrain lesions. This can help in precise localization of the lesion in nuclear and perinuclear 3rd-nerve palsies 1 ( figure 1C).Presentation of supranuclear lesions. The oculomotor nuclear complex is situated in the midbrain at the level of the superior colliculus, ventral to the periaqueductal gray matter. It is composed of paired and unpaired subnuclei and lesions conf...

show abstract

Section: Oy-stersmentioning

confidence: 99%

Section: Oy-stersmentioning

confidence: 99%

Pearls & Oy-sters: Looking up the anatomy of looking up

et al. 2016

View full text Add to dashboard Cite

show abstract

“…1 The oculomotor nucleus comprises several subnuclei involved in control of different ocular functions. 2,3 Fascicles of CN III exit from the rostral/caudal aspect of the nuclear complex and pass through the MLF, red nucleus, substantia nigra, and medial aspect of the cerebral peduncle before exiting the midbrain at the interpeduncular fossa. The nerve then runs between the posterior cerebral artery and the superior cerebellar artery to pass through the basal cisterns.…”

Section: Anatomy Of Oculomotor Nervementioning

confidence: 99%

Value of Eye Movement Examination in Aiding Precise Localization in Stroke

Khandker

Schmerler

Mahajan

et al. 2014

Stroke

View full text Add to dashboard Cite

A 69-year-old black man with vascular risk factors, including hypertension, hyperlipidemia, and poorly controlled diabetes mellitus, who was treated with the vascular endothelial growth factor inhibitor, bevacizumab, for macular degeneration, experienced sudden onset horizontal diplopia associated with fatigue. His deficits did not prevent him from driving. The next morning he noticed right eye ptosis obscuring his vision. Because of worsening symptoms, the patient presented to the emergency department where he was found to have bilateral ptosis, right greater than left, and left internuclear ophthalmoplegia (INO). Pupils were equal and reactive to light. General neurological examination revealed peripheral neuropathy with decreased pinprick/light touch and vibration/ joint position sense distally in the lower extremities with associated difficulty with tandem walk and positive Romberg sign. Initial National Institutes of Health Stroke Scale was 2 for partial gaze palsy and sensory deficits. He did not qualify for thrombolysis because of minor deficits and symptoms lasting longer than 4.5 hours.The patient was admitted to the neurology service with suspected stroke. MRI of the brain revealed a midbrain midline diffusion restriction with apparent diffusion coefficient correlate just ventral to the aqueduct of Sylvius slightly more extended to the right consistent with subacute ischemic stroke involving the nucleus of oculomotor nerve and adjacent medial longitudinal fasciculus (MLF) likely secondary to small-vessel disease. MR angiography of the head and neck did not show significant intracranial or extracranial vascular disease. Transthoracic echocardiogram revealed normal heart function and no patent foramen ovale.The patient was started on aspirin and a statin and provided an eye patch for comfort. His diplopia improved, and he was eventually discharged with follow-up with ophthalmology, balance rehabilitation clinic, and his primary care physician for management of his risk factors.This patient presented with acute onset painless horizontal diplopia and was found on examination to have bilateral ptosis and a left INO in the setting of poorly controlled vascular risk factors and ongoing bevacizumab injections. Here, we will consider the localizing value of our clinical findings and comment briefly on bevacizumab and stroke. Anatomy of Oculomotor NerveThe oculomotor nerve innervates all extraocular muscles, except the lateral rectus (cranial nerve [CN] VI) and superior oblique (CN IV); it also innervates the levator palpebrae, the ciliary body, and pupillary constrictors. Varying degrees of ptosis, gaze palsy, pupillary defects, sometimes with involvement of nearby structures, can be observed with involvement of the oculomotor nerve (CN III) and help identify the exact location of the lesion along the course of the nerve (eg, nuclear, fascicular, and subarachnoid).1 The oculomotor nucleus is a paired structure located in the ventral border of the periaqueductal gray of the midbrain and extends rostrally to the ...

show abstract

“…The initial understanding of the organization of the oculomotor nerve is credited to R. Wa rw i c k 8 , who, in 1953, microscopically observed re t rograde degeneration in the oculomotor nucleus after extirpation of individual extraocular muscles in monkeys. He found that the third nerve nuclei are arranged in clusters that are specific for individual extraocular muscles.…”

Section: Fig 2 Mri With Gadolinium Sagital Slice T1-weighted Image mentioning

confidence: 99%

“…Similarly, when lesions affect the central caudal nucleus, the result is bilateral ptosis. This is because the unpaired nature of the central caudal nucleus sits at the bottom of the oculomotor nuclear complex 1,8,10 .…”

Section: Fig 2 Mri With Gadolinium Sagital Slice T1-weighted Image mentioning

confidence: 99%

Metastasis to the unilateral oculomotor nucleus complex: case report

Maranhão-Filho

Pires

2006

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

-This article describes a 76 years old man that, after lung cancer surgery, showed left extrinsic oculomotor paralysis and contralateral paralysis of the superior rectus muscle associated with bilateral ptosis. Magnetic resonance imaging confirmed a rare situation characterized by an isolated metastasis in the region of the left third cranial nerve nucleus, probably compromising the superior rectus subnucleus and the central caudal nucleus, therefore justifying the bilateral oculomotor involvement.KEY WORDS: Cranial third nerve nucleus, metastasis, ophthalmoplegia.Metástase para o complexo nuclear oculomotor unilateral: relato de caso RESUMO -O presente relato descreve um homem de 76 anos que, após ciru rgia de câncer de pulmão apresentou paralisia oculomotora extrínseca à esquerda e paralisia contralateral do músculo reto superior, além de ptose palpebral bilateral. O exame de ressonância magnética evidenciou uma rara situação caracterizada por metástase isolada na região do núcleo do terc e i ro nervo craniano esquerdo provavelmente comp rometendo o sub-núcleo do reto superior e o núcleo central caudal, justificando assim o envolvimento óculo motor bilateral. PALAVRAS-CHAVE: Núcleo do III nervo cranial, metástase, oftalmoplegia. c a rcinoma in the right lung. A right inferior lobectomy with mediastinal linfadenectomy was done without interc u rrences. Based on the TNM international staging system, his lung cancer was classified as T III N 0 M 0. Ten days later, he had a rapidly pro g ressive bilateral ptosis. Examination revealed a lucid, oriented, and concerned patient, with cranial nerve III extrinsic palsy in the left eye and right ptosis associated with up gaze palsy (Fig 1). His pupils were of medium caliber, symmetric, and responded to light. He could forcefully close his eyes. The fundus oculis was irrem a rcable, and the remainder of the examination was unrevealing. He had no headaches, fever, or signs of intracranial hypertension. Eletro n e u romiography examination was n o rmal and the brain MRI demonstrated a lesion in the midbrain adjacent to the cerebral aqueduct, in the re g i o n of the left oculom otor nucleus (Fig 2). Radiotherapy w as done, and after that, the patient phy sically deteriorated without changes in the oculomotor aspects, until his death one month later. Post Mortem, the patient's daughter has f o rmally given authorization for the publication of this case report.D i ff e rent kinds of lesions can compromise the t h i rdnerve nucleus 1 , 2 . Solitary metastasis to the brainstem is uncommon; isolated metastasis concern i n g the nucleus of the third cranial nerve is even rare r. Ve rtical eye movements are organized in the midbrain, with ipsilateral oculomotor paralysis and contralateral paralysis of the superior rectus muscle, when the third nerve nucleus is unilaterally damaged, associated with bilateral ptosis, when the lesion also affects the central caudal nucleus 3 .The aim of this article is to re p o rt a rare case of bilateral oculomotor signs and magnetic re s ...

show abstract

Representation of the extra‐ocular muscles in the oculomotor nuclei of the monkey

Cited by 265 publications

References 33 publications

Pearls & Oy-sters: Looking up the anatomy of looking up

Pearls & Oy-sters: Looking up the anatomy of looking up

Value of Eye Movement Examination in Aiding Precise Localization in Stroke

Metastasis to the unilateral oculomotor nucleus complex: case report

Contact Info

Product

Resources

About