Neurology®
The most widely read and highly cited peer-reviewed Neurology journal
Quick Search
Advanced Search
This Article
Right arrow Full Text (PDF)
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Halmagyi, G. M.
Right arrow Articles by Hoyt, W. F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Halmagyi, G. M.
Right arrow Articles by Hoyt, W. F.
NEUROLOGY 1990;40:1503
© 1990 American Academy of Neurology

Tonic contraversive ocular tilt reaction due to unilateral meso-diencephalic lesion

G. M. Halmagyi, MB, Th. Brandt, MD, M. Dieterich, MD, I. S. Curthoys, PhD, R. J. Stark, MB and W. F. Hoyt, MD

From the Neurology Department (Dr. Hahagyi), Royal Prince Alfred Hospital, Sydney, Australia; the Neurologische Klinik (Drs. Brandt and Dieterich), Klinikum Grosshadern, Ludwig Maximilians Universität, Munich, Federal Republic of Germany; the Psychology Department (Dr. Curthoys), University of Sydney, Sydney, Australia; the Neurology Department (Dr. Stark), The Alfred Hospital, Melbourne, Australia; and the Neuro-Ophthalmology Unit (Dr. Hoyt), Neurosurgery Department, UCSF, San Francisco, CA.

We studied 4 patients with tonic contraversive ocular tilt reactions due to unilateral, paramedian, meso-diencephalic lesions. This is in contrast to the only 2 previously reported patients with ocular tilt reactions due to unilateral meso-diencephalic lesions, each of whom had a paroxysmal ipsiversive ocular tilt reaction. This new finding is considered in the context of previous clinical and experimental data on the various types of ocular tilt reactions that follow stimulation or destruction of the peripheral and central vestibular system. Otolithic inputs to the interstitial nucleus of Cajal from the contralateral vestibular nucleus and motor outputs from the interstitial nucleus of Cajal to cervical and ocular motoneurons could be involved in the ocular tilt reaction. We propose that in patients with unilateral meso-diencephalic lesions, a tonic contraversive ocular tilt reaction could be due to persistently decreased resting activity of ipsilateral interstitial nucleus neurons, whereas a paroxysmal ipsiversive ocular tilt reaction could be due to transiently increased activity of the same interstitial nucleus neurons. Cases of ocular tilt reaction due to unilateral meso-diencephalic lesion point to the existence of a crossed graviceptive pathway between the vestibular nucleus and the contralateral interstitial nucleus of Cajal.

Address correspondence and reprint requests to Dr. G.M. Halmagyi, Neurology Department, RPA Hospital, Camperdown, NSW 2050, Sydney, Australia.

Supported by the National Health and Medical Research Council of Australia, by the RPAH Neurology Department Trustees (Drs. Halmagyi and Curthop), and by the Deutsche Forschuwggemeinschaft (Drs. Brandt and Dieterich).

Presented at a Clinical Eye Movement Society Meeting, Vancouver, BC, Canada, May 1988.

Received April 25, 1989. Accepted for publication in final form March 20, 1990.




This article has been cited by other articles:


Home page
 NeurologyHome page
A. R. Rodriguez, R. A. Egan, and J. J.S. Barton
Pearls & Oy-sters: Paroxysmal ocular tilt reaction
Neurology, April 14, 2009; 72(15): e67 - e68.
[Full Text] [PDF]

Home page
 IOVSHome page
M. Schlenker, G. Mirabella, H. C. Goltz, P. Kessler, A. W. Blakeman, and A. M. F. Wong
The Linear Vestibulo-Ocular Reflex in Patients with Skew Deviation
Invest. Ophthalmol. Vis. Sci., January 1, 2009; 50(1): 168 - 174.
[Abstract] [Full Text] [PDF]

Home page
 BrainHome page
B. Baier, S. Bense, and M. Dieterich
Are signs of ocular tilt reaction in patients with cerebellar lesions mediated by the dentate nucleus?
Brain, June 1, 2008; 131(6): 1445 - 1454.
[Abstract] [Full Text] [PDF]

Home page
 J. Neurophysiol.Home page
F. Farshadmanesh, E. M. Klier, P. Chang, H. Wang, and J. D. Crawford
Three-Dimensional Eye-Head Coordination After Injection of Muscimol Into the Interstitial Nucleus of Cajal (INC)
J Neurophysiol, March 1, 2007; 97(3): 2322 - 2338.
[Abstract] [Full Text] [PDF]

Home page
 Br J OphthalmolHome page
M C Brodsky
Three dimensions of skew deviation
Br J Ophthalmol, December 1, 2003; 87(12): 1440 - 1441.
[Full Text] [PDF]

Home page
 NeurologyHome page
C. Helmchen, H. Rambold, U. Kempermann, J.A. Buttner-Ennever, and U. Buttner
Localizing value of torsional nystagmus in small midbrain lesions
Neurology, December 24, 2002; 59(12): 1956 - 1964.
[Abstract] [Full Text] [PDF]

Home page
 ScienceHome page
E. M. Klier, H. Wang, A. G. Constantin, and J. D. Crawford
Midbrain Control of Three-Dimensional Head Orientation
Science, February 15, 2002; 295(5558): 1314 - 1316.
[Abstract] [Full Text] [PDF]

Home page
 J. Neurol. Neurosurg. PsychiatryHome page
S TERAO, Y OSANO, T FUKUOKA, N MIURA, T MITSUMA, and G SOBUE
Coexisting vertical and horizontal one and a half syndromes
J. Neurol. Neurosurg. Psychiatry, September 1, 2000; 69(3): 401 - 402.
[Full Text] [PDF]

Home page
 Neurorehabil Neural RepairHome page
T. Brandt and M. Dieterich
Perceived Vertical and Lateropulsion: Clinical Syndromes, Localization, and Prognosis
Neurorehabil Neural Repair, January 1, 2000; 14(1): 1 - 12.
[Abstract] [PDF]

Home page
 Arch OphthalmolHome page
M. C. Brodsky
Dissociated Vertical Divergence: A Righting Reflex Gone Wrong
Arch Ophthalmol, September 1, 1999; 117(9): 1216 - 1222.
[Abstract] [Full Text] [PDF]