Dissociated Vertical Nystagmus and Internuclear Ophthalmoplegia From a Midbrain Infarction

Marshall, Randolph S.; Sacco, Ralph L.; Kreuger, Ronald; Odel, Jeffrey G.; Mohr, J. P.

doi:10.1001/archneur.1991.00530240110032

Cited by 29 publications

(5 citation statements)

References 11 publications

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“…However, in many reports, lack of complete clinical description prevents from knowing whether SD and INO may occur as isolated symptoms. Only INO with torsional nystagmus or with divergent vertical nystagmus have been reported in isolation in patients with involvement of the MLF [5,6]. Our present study of an isolated association of INO and SD is evidence to suggest a common brain stem structure involvement.…”

Section: Discussionsupporting

confidence: 55%

Internuclear Ophthalmoplegia with Skew Deviation

Tilikete

Vighetto²

2000

Eur Neurol

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Section: Discussionsupporting

confidence: 55%

Internuclear Ophthalmoplegia with Skew Deviation

Tilikete

Vighetto²

2000

Eur Neurol

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“…39 -41 In fact, the reversal of anemia has been associated with an improvement in cognitive function. 42 However, adjusting for hematocrit did not alter our results for any measure of kidney function, indicating that the underlying mechanisms related to CKD in this sample are independent of anemia.…”

Section: Discussionmentioning

confidence: 61%

CKD Associates with Cognitive Decline

Khatri¹,

Nickolas²,

Moon

et al. 2009

Journal of the American Society of Nephrology

128

116

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Cognitive impairment and chronic kidney disease (CKD) will become increasingly prevalent in the aging US population. Although evidence exists that CKD is a risk factor for cognitive decline, longitudinal studies are limited and largely have excluded ethnically diverse populations. The Northern Manhattan Study includes a population-based, prospective, stroke-free cohort. We assessed global cognitive function annually using the modified Telephone Interview for Cognitive Status (TICS-m) and estimated kidney function using CockcroftGault creatinine clearance (CCl), Modification of Diet in Renal Disease estimated GFR (eGFR), and serum creatinine (sCr). We examined the association between CKD and change in TICS-m scores over time, adjusting for sociodemographic and vascular risk factors. Of 2172 subjects (mean age 71.5 yr, mean follow-up 2.9 yr), 59% were Hispanic, 20% were black, and 63% were women. Participants with a CCl Ͻ60 ml/min and those with a CCl between 60 and 90 ml/min performed significantly worse on the TICS-m over time than those with a CCl Ͼ90 ml/min, adjusting for potential confounders. Our results were similar when we used eGFR or sCr to estimate kidney function. In conclusion, decreased kidney function associates with greater cognitive decline, even in those with mild CKD. Kidney disease may represent a novel mechanism leading to cognitive impairment and a target for early intervention.

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“…Besides the characteristic dissociated abducting nystagmus, spontaneous nystagmus is often observed in INO-patients ( 5 , 8 , 24 ). In unilateral INO, dissociated vertical-torsional nystagmus (jerky seesaw nystagmus) may be present ( 8 , 25 ). Dissociated vertical-torsional nystagmus in INO has been ascribed to the disruption of vertical-torsional VOR-pathways (from the contralateral ASC/PSC through the MLF to the ocular motor nuclei) or the graviceptive pathways.…”

Section: Discussionmentioning

confidence: 99%

Preferential Impairment of the Contralesional Posterior Semicircular Canal in Internuclear Ophthalmoplegia

Lee

Kim

et al. 2017

Front. Neurol.

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BackgroundThe vertical vestibulo-ocular reflex (VOR) may be impaired in internuclear ophthalmoplegia (INO) as the medial longitudinal fasciculus (MLF) conveys VOR-signals from the vertical semicircular canals. It has been proposed that signals from the contralesional posterior semicircular canal (PSC) are exclusively transmitted through the MLF, while for the contralesional anterior canal other pathways exist.ObjectiveHere, we aimed to characterize dysfunction in individual canals in INO-patients using the video-head-impulse test (vHIT) and to test the hypothesis of dissociated vertical canal impairment in INO.MethodsVideo-head-impulse testing and magnetic resonance imaging were obtained in 21 consecutive patients with unilateral (n = 16) or bilateral (n = 5) INO and 42 controls. VOR-gains and compensatory catch-up saccades were analyzed and the overall function (normal vs. impaired) of each semicircular canal was rated.ResultsIn unilateral INO, largest VOR-gain reductions were noted in the contralesional PSC (0.55 ± 0.11 vs. 0.89 ± 0.08, p < 0.001), while in bilateral INO both posterior (0.43 ± 0.11 vs. 0.89 ± 0.08, p < 0.001) and anterior (0.58 ± 0.19 vs. 0.88 ± 0.09, p < 0.001) canals showed marked drops. Small, but significant VOR-gain reductions were also found in the other canals in unilateral and bilateral INO-patients. Impairment of overall canal function was restricted to the contralesional posterior canal in 60% of unilateral INO-patients, while isolated involvement of the posterior canal was rare in bilateral INO-patients (20%). Reviewers correctly identified the INO-pattern in 15/21 (71%) patients and in all controls (sensitivity = 84.2% [95%-CI = 0.59.5–95.8]; specificity = 95.5% [95%-CI = 83.3–99.2]).ConclusionUsing a vHIT based overall rating of canal function, the correct INO-pattern could be identified with high accuracy. The predominant and often selective impairment of the contralesional posterior canal in unilateral INO further supports the role of the MLF in transmitting posterior canal signals. In patients with acute dizziness and abnormal vHIT-results, central pathologies such as INO should be considered as well, especially when the posterior canal is involved.

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Dissociated Vertical Nystagmus and Internuclear Ophthalmoplegia From a Midbrain Infarction

Cited by 29 publications

References 11 publications

Internuclear Ophthalmoplegia with Skew Deviation

Internuclear Ophthalmoplegia with Skew Deviation

CKD Associates with Cognitive Decline

Preferential Impairment of the Contralesional Posterior Semicircular Canal in Internuclear Ophthalmoplegia

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