Abnormal Eye Movements in Palatal Tremor from Brainstem Stroke
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background : Acquired pendular nystagmus is associated with palatal tremor (PT) in the syndrome of oculopalatal myoclonus (OPM). Mixed torsional and vertical pendular nystagmus in OPM has been considered to signify unilateral brainstem damage and symmetrical vertical pendular nystagmus considered to indicate bilateral disease. Methods : In 5 patients with PT from brainstem stroke, involuntary eye movements, saccades, smooth pursuit, and the vestibulo-ocular reflex (VOR) were recorded using a magnetic search coil technique. In one patient, spontaneous eye movements were analyzed by video recording. Results : Four patients showed conjugate vertical pendular nystagmus at 2-3 Hz. Mixed torsional and vertical pendular nystagmus was observed in one patient. Another patient had both converg e n t-divergent and vertical pendular nystagmus. In three patients, intermittent ocular jerks, consisting of double saccadic pulses with no or variable interval between sequential saccades in each couplet, were superimposed on the pendular smooth eye movement. One patient showed frequent square wave jerks and macrosaccadic oscillations. Internuclear ophthalmoplegia, gaze palsy, or abducens palsy were frequently associated oculomotor findings, as were the hypermetric saccades, defective smooth pursuit, and hypoactive VOR. MRI demonstrated unilateral or bilateral inferior olivary pseudohypertrophy in all patients studied. Bilateral olivary change was associated with conjugate vertical pendular nystagmus in two patients. Unilateral olivary lesion was observed with conjugate vertical pendular nystagmus in two patients, and with mixed torsional-vertical pendular nystagmus in one patient. Conclusions : Ocular oscillations in PT vary. Conjugate vertical pendular nystagmus can accompany either unilateral or bilateral changes of the inferior olivary nucleus. Distinction between conjugate vertical pendular nystagmus indicating midline or bilateral lesions, and mixed torsional and vertical nystagmus indicating unilateral form is not supported by the results of brain imaging. Korean Journal of Stroke 1999;1(2): 175~181
Abstract
Background : Acquired pendular nystagmus is associated with palatal tremor (PT) in the syndrome of oculopalatal myoclonus (OPM). Mixed torsional and vertical pendular nystagmus in OPM has been considered to signify unilateral brainstem damage and symmetrical vertical pendular nystagmus considered to indicate bilateral disease. Methods : In 5 patients with PT from brainstem stroke, involuntary eye movements, saccades, smooth pursuit, and the vestibulo-ocular reflex (VOR) were recorded using a magnetic search coil technique. In one patient, spontaneous eye movements were analyzed by video recording. Results : Four patients showed conjugate vertical pendular nystagmus at 2-3 Hz. Mixed torsional and vertical pendular nystagmus was observed in one patient. Another patient had both converg e n t-divergent and vertical pendular nystagmus. In three patients, intermittent ocular jerks, consisting of double saccadic pulses with no or variable interval between sequential saccades in each couplet, were superimposed on the pendular smooth eye movement. One patient showed frequent square wave jerks and macrosaccadic oscillations. Internuclear ophthalmoplegia, gaze palsy, or abducens palsy were frequently associated oculomotor findings, as were the hypermetric saccades, defective smooth pursuit, and hypoactive VOR. MRI demonstrated unilateral or bilateral inferior olivary pseudohypertrophy in all patients studied. Bilateral olivary change was associated with conjugate vertical pendular nystagmus in two patients. Unilateral olivary lesion was observed with conjugate vertical pendular nystagmus in two patients, and with mixed torsional-vertical pendular nystagmus in one patient. Conclusions : Ocular oscillations in PT vary. Conjugate vertical pendular nystagmus can accompany either unilateral or bilateral changes of the inferior olivary nucleus. Distinction between conjugate vertical pendular nystagmus indicating midline or bilateral lesions, and mixed torsional and vertical nystagmus indicating unilateral form is not supported by the results of brain imaging. Korean Journal of Stroke 1999;1(2): 175~181