Palsies of the Conjugate Ocular Movements

Holmes, Gordon

doi:10.1136/bjo.5.6.241

Cited by 35 publications

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“…It will be recalled that the nystagmus became most marked when the eyes were turned toward the most defective visual field while the head was turned in the opposite direction. It is possible to agree with Holmes (1921) and say that this was nystagmus secondary to a defective fixation reflex since vision was partly intact. However, it is not altogether clear why the position of the head should play a role in this symptom and why, as in the second case, it is possible to have attacks of clonic adversive eye movements without evidence of a fixation deficit or visual experience.…”

Section: Discussionmentioning

confidence: 66%

“…When it is bilateral it becomes even more marked. The post-mortem examinations of cases by Gordon Holmes (1921) revealed that this defect in fixation was related to "interruption of the cortico-tectal fibres which form the efferent link 139 of the reflex arch; the disease involved the dorsal portion of the thalamus including the pulvinar". In addition, Gordon Holmes described occipital lesions as producing paresis of gaze to the side opposite the lesion.…”

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confidence: 99%

“…Dejerine and Roussy (1905) observed such paresis after a recent occipital injury in a previously blind person, suggesting that vision is not the factor in these cases. Gordon Holmes (1921) also noted that many hemianopics could not accurately fixate targets on the hemianopic side, despite preservation of macular vision and accurate fixation of a target in the midline. Holmes concluded that such a defect could not be due to visual loss but was due to unilateral loss of the visual reflexes needed for maintaining the position of the eyes achieved by voluntary ocular movement.…”

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confidence: 99%

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Disorders of Oculomotor Function in Lesions of the Occipital Lobe

Bender¹,

Postel²,

Krieger³

1957

Journal of Neurology, Neurosurgery & Psychiatry

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Section: Discussionmentioning

confidence: 66%

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confidence: 99%

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confidence: 99%

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Disorders of Oculomotor Function in Lesions of the Occipital Lobe

Bender¹,

Postel²,

Krieger³

1957

Journal of Neurology, Neurosurgery & Psychiatry

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“…With alteration of position, the receptor organs are probably the vestibular apparatus and receptors in the neck muscles (Joppich andSchulte 1968, Sanders andBird 1970). Downward rotatory movements are mediated by the oculomotor and the trochlear nerves, which innervate the inferior rectus and superior oblique muscles respectively.…”

Section: Discussionmentioning

confidence: 99%

The Setting‐sun Eye Phenomenon in Infancy

Cernerud

1975

Develop Med Child Neuro

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SUMMARY In a longitudinal study, 19 infants who displayed the setting‐sun eye phenomenon were observed during the first year of life. Nine of the infants showed no signs of illness, eight had an evident increase in intracranial pressure requiring surgical relief, and two had transient signs of increased intracranial pressure which resolved spontaneously. The setting‐sun phenomenon could be elicited both by alteration of the infant's position and by removal of light, and it also occurred spontaneously. The effectiveness of the eliciting mechanism depended on the age of the infant. The component parts of the phenomenon consist of downward rotation of the eyeballs and retraction of the upper eyelids, sometimes accompanied by raising of the brow. The phenomenon can be observed in healthy infants, and its value in early recognition of increased intracranial pressure is limited. The response might indicate increased intracranial pressure if it can be elicited by alteration of position in infants older than four weeks of age or if there is a marked response to removal of light in infants younger than eight weeks or older than 20 weeks of age, especially if the response is combined with constant or intermittent strabismus or undulating eye‐movements. RÉSUMÉ Le signe du voucher de soleil chez le nourrisson Le signe du coucher de soleil a étéétudié au cours d'une étude longitudinale chez 19 nourrisons ayant présenté ce symptome au cours de la première année de la vie. Neuf enfants ne présentaient aucun symptôme pathologique; il y avait une hypertension intra‐crânienne ayant nécessité une intervention chirurgicale chez huit autres; deux nourrissons avaient présenté des signes transitoires d'hypertension intracrânienne qui avaient évolué spontanément vers la guérison. Le signe du coucher de soleil pouvait être provoqué par la modification de la position du nourrisson et par la diminution de la lumière. Il survenait également spontanément. Le mécanisme déclenchant dépend de l'âge de l'enfant. La principale composante est une rotation vers le bas et une rétraction de la paupière superieure quelque fois associée à une élévation du sourcil. Le symptôme peut être observé chez des enfants en bonne santé. La valeur du signe du coucher de soleil dans le diagnostic précoce de l'hypertension intracrânienne est limitée. Chez des nourrissons de plus de quatre semaines, il peut indiquer une hypertension intracrânienne s'il est produit par une modification de la position; chez les enfants de moins de huit semaines ou de plus de vingt semaines, il a la même valeur s'il est observé après diminution de la lumière, spécialement s'il est associéà un strabisme constant ou intermittent ou encore à des mouvements ondulatoires de l'oeil. ZUSAMMENFASSUNG Das Sonnenuntergangsphänomen im Säuglingsalter In einer Longitudinalstudie wurde das Sonnenuntergangsphänomen bei 19 Säuglingen untersucht, die dieses Phänomen während des ersten Lebensjahres zeigten. Neun Säuglinge waren ohne Krankheit, acht zeigten Symptome erhöhten intrakraniellen Drucks, der ei...

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“…) aqueductal stenosis who had paralysis of upward gaze and pupillary abnormalities. Subsequently, there have been isolated case reports of upward gaze paralysis occurring in hydrocephalus, mostly of later onset (Globus and Bergman, 1946;case 1;Beckett et al, 1950, case 8;Cassinari et al, 1963;Nag and Falconer, 1966, case 8;Lerner et al, 1969;Jerva and Nelson, 1971;Shallat et al, 1973;and Swash, 1974); however, this reported association has not found its way into the leading textbooks of neuro-ophthalmology of Kestenbaum (1946), Cogan (1956), and Walsh and Hoyt (1969) and the review articles of Holmes (1921), Smith et al, (1959), Segarra and Ojeman (1961), and Hatcher and Klintworth (1966).…”

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Sylvian aqueduct syndrome as a sign of acute obstructive hydrocephalus in children.

Chattha¹,

DeLong²

1975

Journal of Neurology, Neurosurgery & Psychiatry

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SYNOPSIS Eight cases of obstructive hydrocephalus manifesting palsy of upward gaze and other features of the Sylvian aqueduct syndrome are reported. During the crisis of intracranial hypertension, all of them developed upward gaze palsy and variable abnormalities of the convergence mechanism such as paralysis, spasm, and convergence nystagmus. The frequent apparent blindness was probably related to gaze paralysis, since visual evoked responses were present. All these ocular abnormalities disappeared after shunting. Periaqueductal dysfunction on the basis of raised intracranial pressure is postulated as the possible mechanism for the above ocular manifestations. The ' setting sun' sign is frequently seen in infants and children with hydrocephalus and has been considered in the past to result from displacement of eyeballs by pressure from the orbital roof plate. Our observations would suggest periaqueductal dysfunction rather than the mechanical displacement as the possible mechanism for this sign.

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Palsies of the Conjugate Ocular Movements

Cited by 35 publications

References 0 publications

Disorders of Oculomotor Function in Lesions of the Occipital Lobe

Disorders of Oculomotor Function in Lesions of the Occipital Lobe

The Setting‐sun Eye Phenomenon in Infancy

Sylvian aqueduct syndrome as a sign of acute obstructive hydrocephalus in children.

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