Abnormal Vertical Eye Movements Research Articles

A late-preterm neonate with germinal matrix hemorrhages and rapidly resolving abnormal vertical eye movements

A late-preterm neonate with germinal matrix hemorrhages and rapidly resolving abnormal vertical eye movements

A Case of Rapidly Resolving Abnormal Vertical Eye Movements in a Late-Preterm Neonate with Germinal Matrix Hemorrhages.

A Case of Rapidly Resolving Abnormal Vertical Eye Movements in a Late-Preterm Neonate with Germinal Matrix Hemorrhages.

Modified Y Splitting of Lateral Rectus in Treatment of Abnormal Vertical Eye Movements Combined with Globe Retraction in Duane Retraction Syndrome

Duane retraction syndrome is the most frequently seen restrictive ocular motility disorders. It is clinically presented with limitation of horizontal movement, variable amounts of upshoots or downshoots and globe retraction combined with narrowing of the palpebral aperture on attempted adduction. An 8-year-old patient presented with severe restriction of abduction, reciprocal upshots or downshoots, and globe retraction combined with the palpebral fissure narrowing of on adduction. After the modified Y splitting of LR and recession of both horizontal rectus operation, all cosmetically disfiguring clinical features disappeared. In this case report modified Y splitting procedure and its long-term efficacy is presented.

Abnormal Vertical Eye Movements as a Clue for Diagnosis of Niemann–Pick Type C

Abnormal Vertical Eye Movements as a Clue for Diagnosis of Niemann–Pick Type C

Duane syndrome in association with 48,XXYY karyotype

Duane syndrome is an ocular motility disorder consisting of deficient horizontal eye movements, eyelid retraction, palpebral fissure narrowing, and abnormal vertical eye movements. It occurs in 1%-5% of patients with strabismus and has also been reported in several syndromes and chromosome abnormalities. Although most cases are sporadic, autosomal-dominant inheritance is seen in up to 10% of cases. Recently, Duane syndrome has been reported to occur in the setting of chromosomal duplication. The 48,XXYY syndrome is a rare syndrome involving duplication of the sex chromosomes. Ocular abnormalities are not typical of this condition. We report the first case of Duane syndrome presenting in an 8-month-old boy with XXYY syndrome. This case lends further support to the association of chromosomal duplication and Duane syndrome.

Duane retraction syndrome.

Duane retraction syndrome (DRS) consists of deficient horizontal eye movements, eyelid retraction, palpebral fissure narrowing, and abnormal vertical eye movements. Most cases are sporadic and unilateral (usually left side) with a slight female predominance. Several associated ocular and systemic conditions have been described in DRS patients. In most cases, the abducens nucleus and nerve are absent or hypoplastic, and the lateral rectus muscle is innervated by a branch of the oculomotor nerve. However, there may be contributing mechanical abnormalities. Type I DRS (primary gaze position esotropia with limitation of abduction) comprises the majority of cases. Approximately 50% of type I DRS patients are orthophoric in primary gaze. Esotropia is the most common type of strabismus encountered, and characteristic up shoots and down shoots occur in adduction. Surgical intervention has gradually become more popular in order to improve the primary gaze alignment and mitigate some of the associated abnormalities in ocular motility. However, patients are rarely rendered clinically normal, and limited expectations are appropriate.

Vertical saccade palsy: a presenting sign of Niemann‐Pick type IIS

An 8 year old sister of a patient undergoing investigations for Niemann-Pick type IIS was observed to have mild difficulties in making downward saccades. She had no other symptoms apart from longstanding mild learning difficulties. Detailed eye movement assessment, using horizontal and vertical electro-oculography and video monitoring, revealed normal horizontal but abnormal vertical eye movements. Vertical downward saccades were absent and could only be achieved by mobilizing the bead to allow for headthrusts. Upward saccades were present at initial presentation, however a subsequent recording after 10 months revealed an inability to make upward saccades unless accompanied by blinks. Vertical optokinetic nystagmus was absent, although vertical smooth pursuit and vestibular ocular reflex were present. Cultured skin fibroblasts showed defective cholesterol esterification which confirmed the diagnosis of Niemann-Pick type IIS (previously known as type C). Vertical saccade palsy has been described as part of the neurological deficits, however it has not been previously reported as the presenting sign of Niemann-Pick type IIS.

Lesions of the posterior commissure disable the vertical neural integrator of the primate oculomotor system.

1. Spontaneous saccades, vestibuloocular responses (VOR), and optokinetic nystagmus were recorded in three squirrel monkeys before and after chemical or electrolytic lesion of the posterior commissure (PC). 2. PC lesions produced abnormal vertical eye movements, in particular, 1) Postsaccadic drifts, and 2) VOR gain reduction and phase advance more pronounced at lower frequencies of sinusoidal head rotation. Horizontal eye movements were much less affected (or normal). 3. We conclude that PC fibers are necessary for conveying the output of the vertical neural integrator to vertical oculomotor-neurons.

視床梗塞により生じたふくそう眼振の２症例

Convergence nystagmus, which is a main finding in Sylvian aqueduct syndrome is not common. We examined two patients of convergence nystagmus associated with infarction of the thalamus. The patients, aged 21 and 64-years, visited our clinic because of sudden dizziness. There was no cochlear sign in either case. Neurotological examinations, including electronystagmography (ENG), were carried out. Both patients had up-beat nystagmus, convergence nystagmus and abnormal vertical eye movements; however, no upward gaze palsy was observed. One patient showed a normal response to caloric testing, but the other showed rt-canal paresis (41%). On computerized tomography (CT scan), no lesion could be identified in the midbrain or thalamus of either patient. However, in one patient, T2-weighted MRI revealed a high signal region and Ti-weighted MRI demonstrated a low signal region in the lt-medial part of the thalamus. In the second patient, T2-weighted MRI revealed multiple bilateral lacunar high signal lesions in the thalamus, the putamen and in the region of the deep white matter. The etiology of abnormal vertical eye movements and convergence nystagmus is discussed with emphasis on the neurotological examinations and MRI.Convergence nystagmus may be associated with lesions of the posterior commisure and nucleus in the medial part of the thalamus, and abnormal vertical eye movements may be attributed to a lesion in the tract from ri-MLF to the posterior commisure.

Stroke Involving the Midbrain and Thalamus and Causing “Nonfocal” Coma

We have described two patients who had coma without focal findings and who were found to have an ischemic stroke involving the midbrain and the thalamus. In both cases metabolic encephalopathy or drug overdose was initially suspected, but recognition of abnormal vertical eye movements led to the proper diagnosis. Examination of vertical eye movements in drowsy or comatose patients may be helpful in arriving at the correct diagnosis early and may prevent unnecessary investigations.