| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Departments of Neurology and Anatomy (Dr. Büttner-Ennever), University of Lübeck (Drs. Helmchen and Rambold), and University of Munich (Drs. Kempermann, Büttner-Ennever, and Büttner), Germany.
Address correspondence and reprint requests to Prof. Dr. Christoph Helmchen, Department of Neurology, Medical University Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany; e-mail: helmchen_ch{at}neuro.mu-luebeck.de
Background: The topodiagnostic value and specificity of nystagmus in patients with mesencephalic lesions and its relation to tonic torsional deficits and vertical saccade deficits is controversial and anecdotal.
Methods: The authors examined 11 patients with vascular MRI-identified mesencephalic lesions and clinical evidence of vertical-torsional nystagmus on gaze straight ahead, focusing on the three-dimensional nystagmus components recorded with the three-dimensional search coil technique.
Results: Combined lesions of the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF) and the interstitial nucleus of Cajal (iC) are much more frequent than riMLF and, in particular, iC lesions alone. Eight patients showed contralesional torsional nystagmus with a conjugate vertical component on gaze straight ahead and had anatomic (MRI) and clinical evidence (slowing of vertical saccades) for riMLF involvement. Tonic ocular torsion and the subjective visual vertical were shifted to the contralesional side (n = 7). Torsional nystagmus to the ipsilesional side was uncommon (n = 3) and found in patients with midbrain lesions involving the iC, all of whom also had decreased time constants of the slow phases of gaze-evoked nystagmus.
Conclusions: Contrary to previous proposals, contralesional torsional nystagmus was the most frequent direction and is probably not compensatory for contralesional tonic ocular torsion. Small amplitude vertical saccades with normal velocities in association with ipsilesional torsional nystagmus may indicate isolated iC lesions. Torsional nystagmus following mesencephalic lesions may last for years and may help to distinguish rostral (riMLF) from caudal (iC) midbrain lesions.
This article has been cited by other articles:
|
|
 |
|
  T. C. Frohman, S. Galetta, R. Fox, D. Solomon, D. Straumann, M. Filippi, D. Zee, and E. M. Frohman Pearls & Oy-sters: The medial longitudinal fasciculus in ocular motor physiology Neurology, April 22, 2008; 70(17): e57 - e67. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Kremmyda, J. A Buttner-Ennever, U. Buttner, and S. Glasauer Torsional deviations with voluntary saccades caused by a unilateral midbrain lesion J. Neurol. Neurosurg. Psychiatry, October 1, 2007; 78(10): 1155 - 1157. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C Helmchen, E Gehrking, S Gottschalk, and H Rambold Persistence of perilymph fistula mechanism in a completely paretic posterior semicircular canal J. Neurol. Neurosurg. Psychiatry, February 1, 2005; 76(2): 280 - 282. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. von Brevern, D. Zeise, H. Neuhauser, A. H. Clarke, and T. Lempert Acute migrainous vertigo: clinical and oculographic findings Brain, February 1, 2005; 128(2): 365 - 374. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Rambold, J. Boenki, G. Stritzke, F. Wisst, B. Neppert, and C. Helmchen Differential vestibular dysfunction in sudden unilateral hearing loss Neurology, January 11, 2005; 64(1): 148 - 151. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Helmchen, A. Sprenger, H. Rambold, T. Sander, D. Kompf, and D. Straumann Effect of 3,4-diaminopyridine on the gravity dependence of ocular drift in downbeat nystagmus Neurology, August 24, 2004; 63(4): 752 - 753. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
