Patterns of dissociate torsional-vertical nystagmus in internuclear ophthalmoplegia

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 co...

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Bibliographic Details
Published in:Annals of the New York Academy of Sciences 2011-09, Vol.1233 (1), p.271-278
Main Authors: Jeong, Seong-Hae, Kim, Eung Kyu, Lee, Jun, Choi, Kwang-Dong, Kim, Ji Soo
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Camber
Damage
Eye Movement Measurements
Eye Movements - physiology
Eyes
Female
Humans
internuclear ophthalmoplegia
Magnetic Resonance Imaging
Male
medial longitudinal fasciculus
Middle Aged
Nystagmus
Nystagmus, Pathologic - complications
Nystagmus, Pathologic - physiopathology
Ocular Motility Disorders - complications
Ocular Motility Disorders - physiopathology
Pathways
Patients
Saccule and Utricle - innervation
Saccule and Utricle - physiopathology
seesaw nystagmus
Semicircular canals
Semicircular Canals - innervation
Semicircular Canals - physiopathology
Tilt
vertigo
vestibulo-ocular reflex
Visual Pathways - physiopathology
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Summary: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.
ISSN:0077-8923
1749-6632
DOI:10.1111/j.1749-6632.2011.06155.x