Lateropulsion

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Identifier 161-21
Title Lateropulsion
Ocular Movements Deviation of the Eyes Under Closed Lids; Lateropulsion
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
Supplementary Materials PowerPoint presentation: Multiple Sclerosis Lateropulsion: http://library.med.utah.edu/NOVEL/Wray/PPT/Multiple_Sclerosis_Lateropulsion.ppt Shirley H. Wray, M.D., Ph.D., FRCP, Harvard Medical School
Presenting Symptom Unsteady gait
History This 44 year old woman has a diagnosis of Multiple Sclerosis.
Clinical This short eye movement clip in a patient with MS shows: • Lateropulsion (deviation) of the eyes, towards the side of the lesion, under closed lids. • The eyes are conjugately deviate to the left in this patient • On opening the eyes and on blinking there is a fast corrective horizontal saccade to move the eyes to the primary position • With forced eyelid closure the eyes show normal upward deviation (intact Bell's) • Full eye movements • No nystagmus Lateropulsion of saccades in this case may reflect interruption of axons running in the inferior cerebellar peduncle from the inferior olivary nucleus to the cerebellum. Figure 1 shows a hypothetical scheme to account for lateropulsion of saccades. Interruption of climbing fibers originating from the inferior olivary nucleus may occur prior to their crossing in the medulla (1)or as they enter the inferior cerebellar peduncle in Wallenberg's syndrome. (2) Loss of climbing fiber inputs to Purkinje cells in the dorsal vermis causes the latter to inhibit the fastigial nucleus (4), which causes ipsipulsion of saccades. Pharmacological inactivation of the dorsal vermis (3) causes contrapulsion (although clinical lesions produce bilateral hypometria). Interruption of crossed fastigial nucleus outputs in the superior cerebellar peduncle (uncinate fasciculus, (5) causes contrapulsion. Thus contrapulcsion arises at sites 1, 3 and 5 and ipsipulsion at sites 2-4. Taken from Leigh RJ, Zee DS. The Saccadic System. Chp 3; 108-187. In: The Neurology of Eye Movements 4th Edition. Oxford University Press, New York 2006 with permission. This case should be viewed alongside ID209-1 - a patient with lateropulsion and Wallenberg's syndrome.
Neuroimaging Neuroimaging studies were not available in this patient. Illustrative images in another MS case are shown here. Brain MRI Figures 2-4 show a series of axial and sagittal FLAIR scans with classic calloseptal and deep periventricular foci of increased signal intensity surrounding cavitating areas characteristic of long-standing MS. Figure 4 shows perpendicular orientation of foci towards the ventricle, classic for Dawson fingers. Courtesy of Anne Osborn, M.D.
Anatomy Figure 1
Pathology Demyelination
Etiology Multiple Sclerosis
Disease/Diagnosis Multiple Sclerosis
Treatment See ID 941-1
References 1. Frohman EM, Frohman TC, Fleckenstein J, Racke MK, Hawker K, Kramer PD. Ocular contrapulsion in multiple sclerosis: clinical features and pathophysiological mechanisms. J Neurol Neurosurg Psychiatry 2001; 70:688-692. http://www.ncbi.nlm.nih.gov/pubmed/11309470 2 Hain TC, Zee DS, Mordes M. Blink-induced saccadic oscillations. Ann Neurol 1986;19:299-301. http://www.ncbi.nlm.nih.gov/pubmed/3963775 3. Leigh RJ, Zee DS. The Saccadic System. Chp10;108-187. In: The Neurology of Eye Movements 4th Edition. Oxford University Press, New York 2006.
Relation is Part of 207-1, 209-1
Contributor Secondary Anne Osborn, M.D., University of Utah Medical Center; Ray Balhornm Video Compressionist
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 1982
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/s6380688
Setname ehsl_novel_shw
Date Created 2007-03-20
Date Modified 2017-11-22
ID 188599
Reference URL https://collections.lib.utah.edu/ark:/87278/s6380688
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