| Affiliation |
(DEDB) Professor of Neurology, Harvard Medical School, Harvard University, Boston, Massachusetts; (RBD) Department of Neurology, School of Medicine, University of Miami, Miami, Florida |
| OCR Text |
Show NEW ENGLAND REGIONAL PRIMATE RESEARCH CENTER HARVARD MEDICAL SCHOOL ■ OUTH ■ O"OUQH. April MAa ■ ACHU ■ STTe 0177& 1 1 1969 Dr. Robert B. Daroff Department of Neurology School of Medicine P.O. Box 875 Biscayne Annex Miami, Florida 33152 Dear Dr. Daroff: Thank you very much for your letter of March 20th. The problem of tonic reflex deviation of the eyes is a most complex one and I do not think that there is any good anatomical answer as yet. Patients exhibiting this phenomenon have been, in my experience, either demonstrating it as a transient periodic abnormality on a basis of a very diffuse disease, such as the "oculogyric crisis" of postencephalitic parkinsonism or patients in prolonged unresponsive states of the kind usually called "coma vigil". In the first type there may be no consistent abnormality of ocular movement apart from transient spasm although it is common for a spasm to be initiated by some strong voluntary deviation of eyes in a specific direction. For example, one of my patients had his first oculogyric crisis when he looked up to a clock in a railroad station and then was unable to get his eyes down for 10 - 15 minutes. __Thesecond type of this disorder is that of a patient in a mute, unre onsiv es follow the movem ts 2,._ anot er person around the room. It is in such patients that the eyes are attracted to any movin stim h nomenon of this type that I illustrate in that at· nt thee es were regularly deviated to the right attracted to the left b stimulus. ype o isorder requires a loss of the cortical me h n, tough in experimental animals the phenomenon has been reproduced ----=---:--';__----.Area 17 has been ablated yet with large parts in Areas 18 and 19 remaining. This is as described in the "Parietal Preparation" in the paper with Chambers in the ARNMD,Vol. 36 and an earlier abstract in the Archives of Neurology and Psychiatry, Vol. 73, page 566, 1955. It is, therefore, difficult to answer your question when you say do these patients always have a visual disturbance, for the post-encephalitic may have a visual disturbance that is only very subtle. Rarely do they have a paralysis of voluntary gaze to the side of the reflex phenomena. Some patients wfth large lesions certainly can follow a slowly moving object into the hemianopic field but it is extremely rare to get this degree of cooperation. Once the omenon is obtained it can persist o te h ti h • f culty e eyes away from the deviation. I hope these remarks will -- be of some assistance. s yo ""-t--_,..,r::J/.--1' D.D-B:mwp /th all best ~ s, ' wishes, |
