Multiple Sclerosis 906-4
Dec 21, 2015
Multiple Sclerosis906-4
Eye Movements
Transient spontaneous primary position upbeat nystagmus with lid nystagmus
Rapid bursts of horizontal square wave oscillations opening her eyes to fix on a target.
Horizontal gaze evoked rotary (torsional) nystagmus
(Rotation of the globe is best seen by observing conjunctival blood
vessels).
Eye Movements
Gaze evoked unsustained upbeat nystagmus
Saccadic pursuit except on downgaze
Saccadic Dysmetria
Hypermetria left gaze to center.
Leigh JR and Zee DS. The Neurology of Eye Movements 4th Edition. Oxford University Press, New York 2006 with permission
Clinical Features of Upbeat Nystagmus
Localizes to the Caudal Medulla with lesion affecting the
Perihypoglossal group of nuclei including
nucleus intercalatus
nucleus of Roller
nucleus of pararaphales
Upbeat Nystagmus
More rostral brainstem lesions may interrupt the ventral tegmental tract containing projections from the vestibular nuclei that receive inputs from the anterior semicircular canal
or
Involve the brachuim conjunctivum in the rostral pons and Medulla.
Upbeat Nystagmus
Leigh JR and Zee DS. The Neurology of Eye Movements 4th Edition. Oxford University Press, New York 2006 with permission
Etiology of Upbeat Nystagmus
Leigh JR and Zee DS. The Neurology of Eye Movements 4th Edition. Oxford University Press, New York 2006 with permission
Clinical Features of Torsional Nystagmus
Neuroimaging
Figure 1 Series of sagittal and axial FLAIR scans show classical calloseptal and deep periventricular foci of increased signal intensity surrounding cavatating areas in this patient with long standing MS
Neuroimaging
Note perpendicular orientationTowards the ventricle classicfor“Dawson fingers”
Note a small foci in the pons
Courtesy of Anne Osborn,M.D.
Leigh RJ, Zee DS. Diagnosis of Nystagmus and Saccadic Intrusion. Chp 10;475-558. In: The Neurology of Eye Movements, 4th Edition, Oxford University Press, New York, 2006.
Tilikete C, Koene A, Nighoghossian N., Vighetto A, Pélisson . Saccadic lateropulsion in Wallenberg syndrome: a window to access cerebellar control of saccades? Exp Brain Res 2006; 174(3);555-65.
References
References
Tilikete C. Hermier M. Pelisson D, Vighetto A. Saccadic lateropulsion and primary position upbeat nystagmus: disorders of caudal medulla. Ann Neurol 2002; 52:658-662.
http://www.library.med.utah.edu/NOVEL