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From the Departments of Neurology (Drs. Averbuch-Heller, Rottach, Suarez, Pettee, Remler, and Leigh), Biomedical Engineering (Drs. Zivotofsky and Leigh), Otolaryngology (Dr. Leigh), and Neuroscience (Dr. Leigh), Department of Veterans Affairs Medical Center and University Hospitals, Case Western Reserve University, Cleveland, OH.
Supported by USPHS grant EY06717, the Department of Veterans Affairs, and the Evenor Armington Fund (to Dr. Leigh), and Deutsche Forschungsgemeinschaft (to Dr. Rottach).
Received March 4, 1996. Accepted in final form May 28, 1996.
Address correspondence and reprint requests to Dr Leigh, Department of Neurology, University Hospitals, 11100 Euclid Avenue, Cleveland, OH 44106-5000.
Article abstract-We measured torsional eye movements induced by sinusoidal rotation or static tilt of the head in roll while viewing a far or near target in 4 patients with skew deviation due to brainstem lesions, 4 patients with spasmodic torticollis (ST), 2 patients with unilateral eighth nerve section (VIIIS), and 10 normal subjects. Torsional nystagmus was present in all 4 patients with skew deviation. In subjects and patients, responses to both sinusoidal and static roll were larger while viewing the far target, consistent with factors dictated by geometry. Response gains to sinusoidal roll were abnormal in 3 patients with skew (increased in one, decreased in two), abnormal in 3 with ST (increased in 1, decreased in 2), and in abnormal both VIIIS patients (decreased). Greater abnormalities were evident in 3 skew patients while rolling away from the side of their brainstem lesions and in both VIIIS patients while rolling toward their lesioned ears. There were similar but less pronounced changes during static head roll. We conclude that patients with skew, ST, and VIIIS may all have abnormal ocular counter-rolling that is more evident during dynamic testing while viewing a far target. Such abnormalities endure because of the limited influence exerted by vision on torsional eye movements.
NEUROLOGY 1997;48: 506-514
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