Ocular Motor Apraxia

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Identifier 162-6
Title Ocular Motor Apraxia
Ocular Movements Failure to Initiate Voluntary Horizontal Saccadic Eye Movements; Head thrust
Creator Shirley H. Wray, M.D., Ph.D., FRCP, Professor of Neurology Harvard Medical School, Director, Unit for Neurovisual Disorders, Massachusetts General Hospital
Contributor Primary Shirley H. Wray, MD, PhD, FRCP, Professor of Neurology, Harvard Medical School; Director, Unit for Neurovisual Disorders, Massachusetts General Hospital
Subject Acquired Ocular Motor Apraxia; CNS degenerative disease; Head Thrust; Frontotemporal Dementia; Ocular Motor Apraxia
Supplementary Materials PowerPoint Presentation: Tauopathies - a contemporary way to consider a set of neurodegenerative disease based on molecular signature: http://library.med.utah.edu/NOVEL/Wray/PPT/Tauopathies_guest_lecture.ppt John Growdon, M.D. Massachusetts General Hospital
Presenting Symptom Jerky head movements
History This elderly patient was referred to the Movement Disorder Clinic for evaluation of abnormal head thrust movements when asked to look on command to the right or to the left. His random eye movements were full vertically and horizontally. Diagnosis: Acquired Ocular Motor Apraxia Frontotemporal Atrophy. This rare case, recorded on film in 1972, is included in the collection as an example of acquired ocular motor apraxia in an adult. Another patient with frontotemporal lobe atrophy ID#925-3 has unilateral impairment of initiation of voluntary horizontal saccades and fails to look left on command.
Clinical This man with neurodegenerative disease shows the characteristic ocular motor signs of ocular motor apraxia. • Intermittent failure to initiate horizontal saccades to right and left • Rapid head thrusts to fixate a target • When the eyes are looking to the right, in order to fixate a target in primary position, the child thrusts his head to the left to trigger vestibular induced saccades to change gaze. • The head overshoots the position of the target of attention but, once fixation is attained, the head turns back to the primary position. There are three strategies that can be used to initiate horizontal saccades in OMA 1. by using the vestibulo-ocular reflex (VOR) to drag the eyes around 2. by blinks which turn off the omnipause neurons in the pons to allow the excitatory burst neurons to fire and generate a saccadic eye movement and/or 3. by simultaneous elicited eye and head movements which use central head commands to initiate horizontal saccades while suppressing the VOR.
Neuroimaging N/A
Anatomy The brain generates eye movements by processing information in multiple cortical areas - the eye fields. The frontal eye field generates intentional saccades to visual targets, reflective saccades, memory-guided saccades and anti-saccades. The parietal eye field initiates visuospatial attention by triggering visually guided reflective saccades and disengaging fixation. At the cortical level potential targets for gaze are analyzed and selected and the decision is made to execute a saccadic eye movement from one target to another or a pursuit eye movement to follow a moving target. In this patient with failure to initiate voluntary horizontal saccades cerebral atrophy is likely to have affected both the frontal and parietal eye fields.
Etiology The brain generates eye movements by processing information in multiple cortical areas - the eye fields. The frontal eye field generates intentional saccades to visual targets, reflective saccades, memory-guided saccades and anti-saccades. The parietal eye field initiates visuospatial attention by triggering visually guided reflective saccades and disengaging fixation. At the cortical level potential targets for gaze are analyzed and selected and the decision is made to execute a saccadic eye movement from one target to another or a pursuit eye movement to follow a moving target. In this patient with failure to initiate voluntary horizontal saccades cerebral atrophy is likely to have affected both the frontal and parietal eye fields.
Disease/Diagnosis Frontotemporal Atophy; CNS Degenerative Disease; Ocular Motor Apraxia
Treatment There are no eye exercises to correct this ocular motility disorder.
References 1. Cogan DG. A type of congenital ocular motor apraxia presenting jerky head movements. Trans Am Acad Ophthalmol 1952;56:853-858. http://www.ncbi.nlm.nih.gov/pubmed/13005548 2. Fletcher WA, Sharpe JA. Saccadic eye movement dysfunction in Alzheimer's disease. Ann Neurol 1986;20:464-471. http://www.ncbi.nlm.nih.gov/pubmed/3789662 3. Lasker AG, Zee DS, Hain TC, Folstein SE, Singer HS. Saccades in Huntington's disease: Initiation defects and distractibility. Neurology 1987;37:364-370. http://www.ncbi.nlm.nih.gov/pubmed/2950337 4. Leigh RJ, Zee DS. The Neurology of Eye Movements. 4th Ed. Oxford University Press, New York 2006. 5. Pierrot-Deseilligny C, Gautier JC, Loron P. Acquired ocular motor apraxia due to bilateral frontoparietal infarcts. Ann Neurol 1988;23:199-202. http://www.ncbi.nlm.nih.gov/pubmed/3270327 6. Rambold H, Moser A, Zurowski B, Gbadamosi J, Kompf D, Sprenger A, Helmchen C. Saccade Initiation in ocular motor apraxia. J Neurol 2006;253:950-952. http://www.ncbi.nlm.nih.gov/pubmed/16619125 7. Sharpe JA. Adaptation to frontal lobe lesions. In: Keller EL, Zee DS, eds. Adaptive processes in visual and oculomotor systems. Oxford: Pergamon Press, 1986;239-246. 8. Sharpe, JA, Johnson JL. Ocular motor paresis versus apraxia. Ann of Neurol 1989;25:209. http://www.ncbi.nlm.nih.gov/pubmed/2919873 9. Smith S, Holmes G. A case of bilateral motor apraxia with disturbance of visual orientation. Brit M. J. 1916, 1:437-441. http://www.ncbi.nlm.nih.gov/pubmed/20768059
Relation is Part of 162-2, 162-3, 162-5, 925-3
Contributor Secondary Steve Smith, Videographer; Ray Balhorn, Digital Video Compressionist
Reviewer David Zee, Johns Hopkins, 2007
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 1973
Type Image/MovingImage
Format video/mp4
Source 16mm tape
Rights Management Copyright 2002. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s61g3htr
Setname ehsl_novel_shw
Date Created 2007-03-08
Date Modified 2017-11-22
ID 188584
Reference URL https://collections.lib.utah.edu/ark:/87278/s61g3htr
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