Upward Eye Research Articles

Letter: Stokes-Adams attacks in myasthenia gravis: a possible cholinergic side effect.

The cause of sudden death, which occurs in about one third of myasthenia gravis deaths, is not known. 1 We report a myasthenia patient who had Stokes-Adams attacks that responded to a reduction in anticholinesterase dosage. This probable cholinergic side effect has not previously been reported, to our knowledge, and could account for some cases of sudden death in this disease. Report of a Case.— A 31-year-old white woman had had myasthenia gravis since age 17, requiring several hospitalizations for respiratory failure. Thymectomy had been refused. Estrogen therapy, started because of a menstrual relationship to crises, resulted in improved control. Systemic lupus erythematosus (SLE) was suspected because of a positive antinuclear factor. In March 1973, she was found to be hypertensive (180/125 mm Hg) and began to have several brief blackouts each week, regardless of posture and occasionally accompanied by extensor rigidity and upward eye deviation. Because of the hypertension

Eye movements during sleep. II. The pattern with upward gaze paralysis.

During the night of sleep there is a recurrent cycle of brain wave changes and physiologic events punctuated by the dream periods. When the electroencephalogram changes from a high voltage slow to a low voltage rapid pattern the eyes begin to move in bursts of rapid movement and the dream period begins. The dream periods (stage REM) may be considered as a distinct physiologic state from the rest of the night (non-REM sleep). In patients with paralysis of upward eye movement during waking, during non-REM sleep the eyes moved upward as if no paralysis were present. However, during REM sleep upward eye movement was severely restricted. The results suggest that the functional organization for eye movements during REM sleep is similar to that of waking whereas this organization is dissolved during the remainder of sleep.

Eye movements induced by electric stimulation of the cerebellum in the alert cat

The surface and interior of the cerebellum were electrically stimulated in alert, cervically-transected cats. A variety of patterned eye movements were produced which included horizontal, rotatory, upward and downward eye movements. These eye movements resemble those produced by semicircular canal nerve stimulation. Horizontal eye movements were evoked from the tuber vermis and from the area of the fastigial nuclei. Straight upward and downward eye movements were induced by stimulation of the midline vermis in the anterior and posterior lobes. Downward rotatory eye movements were induced from the region of the interpositus nuclei, from a small area of overlying dorsal cortex, and from the lateral portions of the nodulus and uvula. Rotatory upward eye movements were evoked from ansiform lobes and from the region of the dentate nuclei. Pure rotatory eye movements (wheel rotations) were induced from an area which centered over the brachium conjunctivum at the level of the superior vestibular nuclei. Homotopic cerebellar points gave similar but reversed responses. Ocular responses algebraically summated when two points were simultaneously stimulated. By summating the ocular responses induced by stimulation of different cerebellar points, eye movements could be induced in any spatial plane. These experiments suggest that there is a topographic separation of the neural organizations which produce eye movement in various spatial planes in the cerebellum.