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Department of Neurology, Klinikum Grosshadern, University of Munich, Munich, Germany.
We determined the subjective visual vertical (SW), ocular torsion (OT), skew deviation, and lateral head tilt in 35 patients with acute thalamic infarctions (14 paramedian, 17 posterolateral, and four anterior polar) and in five patients with mesodiencephalic hemorrhages to obtain the tonic effects on vestibular function in the roll plane. Eight of 14 paramedian infarctions had complete ocular tilt reaction (OTR) with contraversive head tilt, skew deviation, OT, and SW tilt. The OTR was due to ischemia of the rostral midbrain tegmentum, including the interstitial nucleus of Cajal (INC), and not to thalamic ischemia. Thus, the INC (and the rostral interstitial nucleus of the medial longitudinal fascicle) is the most rostral brainstem structure mediating eye-head coordination in roll. Eleven of 17 posterolateral infarctions exhibited moderate SW tilts that were either ipsiversive or contraversive. In these 11 cases, vestibular thalamic nuclei (nucleus ventro-oralis intermedius, nucleus ventrocaudalis externus, and nucleus dorsocaudalis) were involved; infarctions in the remaining six were more ventromedial. Anterior polar infarctions did not affect vestibular function in roll.
Address correspondence and reprint requests to Dr. Marianne Dieterich, Department of Neurology, Klinikum Grosshadern, University of Munich, Marchioninistrasse 15, 81377 München, Germany.
Supported by the Deutsche Forschungsgemeinschaft SFB 220, D6, and the Wilhelm-Sander-Stiftung.
Received November 20, 1992. Accepted for publication in final form Feburary 1, 1993.
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