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Abnormalities of torsional fast phase eye movements in unilateral rostral midbrain disease

From the Neuro-Otology Section (P. Riordan-Eva and Drs. Faldon, Bronstein, and Gresty), MRC Human Movement and Balance Unit, Institute of Neurology, London, UK; the Department of Neuro-Ophthalmology (P. Riordan-Eva), National Hospital for Neurology and Neurosurgery, London, UK; the Institute of Neuropathology (Dr. Buttner-Ennever), University of Munich, Germany; and the NMR Research Unit (Dr. Gass), Institute of Neurology, London, UK.
Presented at the 10th Meeting of the International Neuro-Ophthalmological Society, June 1994, Freiburg, Germany.
Received July 14, 1995. Accepted in final form November 21, 1995.
Address correspondence and reprint requests to Mr. P. Riordan-Eva, FRCS FRCOphth, Section of Neuro-Otology, MRC Human Movement and Balance Unit, National Hospital for Neurology and Neurosurgery, 8-11 Queen Square, London WC1N 3BG, UK.

In a patient with a unilateral rostral midbrain lesion, three-dimensional scleral search coil eye movement recordings demonstrated slowing of ipsidirectional torsional fast phase eye movements without any abnormalities of torsional slow phases. On high-resolution MRI, the brainstem lesion localized to the area of the efferent pathways from the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). This supports the experimental finding that unilateral inactivation of the riMLF results in a loss of ipsidirectional torsional fast phase eye movements and the hypothesis that there is lateralization of function throughout the torsional fast eye movement generating system.

NEUROLOGY 1996;47: 201-207

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