Internuclear Ophthalmoplegia Associated with Ipsilateral Downbeat Nystagmus and Contralateral Incyclorotatory Nystagmus

Nozaki, Siro; Mukuno, Kazuo; Ishikawa, Satoshi

doi:10.1159/000309328

Cited by 13 publications

(7 citation statements)

References 11 publications

(16 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

“…INO is often accompanied by a contraversive ocular tilt reaction (OTR) that is largely due to interruption of the graviceptive pathways from the contralateral utricle or the contralateral vertical semicircular canals, which ascend in the MLF after decussation in the lower pons ( 6 , 7 ). Dissociated vertical-torsional nystagmus (jerky seesaw nystagmus) may be present and is explained by disruption of the neural pathways from the contralateral vertical semicircular canals with or without concomitant damage of the fibers from the contralateral utricle ( 5 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Preferential Impairment of the Contralesional Posterior Semicircular Canal in Internuclear Ophthalmoplegia

Lee

Kim

et al. 2017

Front. Neurol.

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preferential Impairment of the Contralesional Posterior Semicircular Canal in Internuclear Ophthalmoplegia

Lee

Kim

et al. 2017

Front. Neurol.

View full text Add to dashboard Cite

show abstract

“…Jerky seesaw nystagmus is a unique form of nystagmus with conjugate torsional but disparate vertical components 4 . The vertical components may be in the opposite directions 4–7 or markedly asymmetric in both eyes 8–10 . Jerky seesaw nystagmus has been reported in lesions involving the brainstem from the medulla to upper mid‐brain.…”

Section: Introductionmentioning

confidence: 99%

“…4 The vertical components may be in the opposite directions [4][5][6][7] or markedly asymmetric in both eyes. [8][9][10] Jerky seesaw nystagmus has been reported in lesions involving the brainstem from the medulla to upper mid-brain. The aim of this study was to elucidate the patterns and mechanisms of jerky seesaw nystagmus in internuclear ophthalmoplegia (INO) by analyzing the nystagmus patterns in 33 patients with dissociated torsionalvertical nystagmus and INO.…”

Section: Introductionmentioning

confidence: 99%

Patterns of dissociate torsional–vertical nystagmus in internuclear ophthalmoplegia

Jeong

Kim

Lee

et al. 2011

Annals of the New York Academy of Sciences

View full text Add to dashboard Cite

To explore the patterns and mechanisms of jerky seesaw nystagmus in internuclear ophthalmoplegia (INO), we analyzed the nystagmus patterns in 33 patients with dissociated torsional-vertical nystagmus and INO. In 11 (33%) patients, the nystagmus was ipsiversive torsional in both eyes with vertical components in the opposite directions. In contrast, 18 (55%) patients showed ipsiversive torsional nystagmus with a larger upbeat component in the contralesional eye. Four (12%) patients exhibited ipsiversive torsional nystagmus with a greater downbeat component in the ipsilesional eye. At least one component of contraversive ocular tilt reaction was associated in most patients (30/33, 91%). The patterns of jerky seesaw nystagmus in INO suggest a disruption of neural pathways from the contralateral vertical semicircular canals with or without concomitant damage to the fibers from the contralateral utricle in or near the medial longitudinal fasciculus.

show abstract

“…Sirs: Monocular downbeat nystagmus is very rare and the responsible lesion site has not yet been determined [1][2][3]. We report a case of unilateral paramedian thalamopeduncular infarction in which ipsilateral oculomotor nerve palsy and contralateral downbeat nystagmus were noted.…”

mentioning

confidence: 99%

Ipsilateral oculomotor nerve palsy and contralateral downbeat nystagmus: a syndrome caused by unilateral paramedian thalamopeduncular infarction

Oishi

Mochizuki

1997

Journal of Neurology

View full text Add to dashboard Cite

Internuclear Ophthalmoplegia Associated with Ipsilateral Downbeat Nystagmus and Contralateral Incyclorotatory Nystagmus

Cited by 13 publications

References 11 publications

Preferential Impairment of the Contralesional Posterior Semicircular Canal in Internuclear Ophthalmoplegia

Preferential Impairment of the Contralesional Posterior Semicircular Canal in Internuclear Ophthalmoplegia

Patterns of dissociate torsional–vertical nystagmus in internuclear ophthalmoplegia

Ipsilateral oculomotor nerve palsy and contralateral downbeat nystagmus: a syndrome caused by unilateral paramedian thalamopeduncular infarction

Contact Info

Product

Resources

About