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Impairment of vertical motion detection and downgaze palsy due to rostral midbrain infarction

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Summary

We present two cases with acute onset of vertical gaze palsy, mainly consisting of impaired downgaze and apraxia of downward head movements, together with neuropsychological deficits (hypersomnia, impaired attention and disorders of memory and affective control). CT and MRI revealed bilateral post-ischaemic lesions in the dorsomedial thalamus and the mesodiencephalic junction, dorsomedial to the red nucleus, thus being restricted to the territory of the posterior thalamosubthalamic paramedian artery, which includes the region of the rostral interstitial nucleus of the medial longitudinal fascicle as the main premotor nucleus for the generation of vertical saccades. In our patients, oculographic examination with electro-oculography and magnetic search coil recording showed severe impairment of downward more than upward saccades and only minor deficits of vertical pursuit and the vestibulo-ocular reflex. Visual functions were normal, with one exception: a psychophysical test of motion perception revealed a significant deficit in the detection of vertical movements. This could be due to a central adaptive mechanism which, in order to minimize oscillopsia, might elevate thresholds for vertical motion perception in cases of vertical gaze palsy. As an alternative explanation, lesions within the midbrain tegmentum could have damaged subcortical visual pathways involved in motion perception.

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References

  1. André-Thomas, Schaeffer H, Bertrand I (1933) Paralysie de l'abaissement du regard: paralysie des inférogyres, hypertonie des supérogyres et des releveurs des paupières. Rev Neurol (Paris) 5:535–552

    Google Scholar 

  2. Bogousslavsky J, Regli F, Uske A (1988) Thalamic infarcts: clinical syndromes, etiology, and prognosis. Neurology 38:837–848

    Google Scholar 

  3. Brandt T, Dieterich M (1986) Peripheral ocular motor palsy impairs motion perception. In: Keller EL, Zee DS (eds) Adaptive processes in visual and oculomotor systems. Pergamon Press, Oxford, pp 457–463

    Google Scholar 

  4. Büttner U, Büttner-Ennever JA, Henn V (1977) Vertical eye movement related activity in the rostral mesencephalic reticular formation of the alert monkey. Brain Res 130:239–252

    Google Scholar 

  5. Büttner-Ennever JA, Büttner U (1978) A cell group associated with vertical eye movements in the rostral mesencephalic reticular formation of the monkey. Brain Res 151:31–47

    Google Scholar 

  6. Büttner-Ennever JA, Büttner U, Cohen B, Baumgartner G (1982) Vertical gaze paralysis and the rostral interstitial nucleus of the medial longitudinal fasciculus. Brain 105:125–149

    Google Scholar 

  7. Carpenter MB, Harbison JW, Peter P (1970) Accessory oculomotor nuclei in the monkey: projections and effects of discrete lesions. J Comp Neurol 140:131–154

    Google Scholar 

  8. Castaigne P, Lhermitte F, Buge A, Escourolle R, Hauer JJ, Lyon-Caen O (1981) Paramedian thalamic and midbrain infarcts. Clinical and pathological study. Ann Neurol 10:127–148

    Google Scholar 

  9. Castiglioni AJ, Gallaway MC, Coulter JD (1978) Spinal projection from the midbrain in monkey. J Comp Neurol 178:329–346

    Google Scholar 

  10. Cogan DC (1974) Paralysis of down-gaze. Arch Ophthalmol 91:192–199

    Google Scholar 

  11. Collewijn H, Steen J van der, Ferman L, Jansen TC (1985) Human ocular counterroll: assessment of static and dynamic properties from electromagnetic search coil recordings. Exp Brain Res 59:185–196

    Google Scholar 

  12. Collewijn H, Steen J van der, Steinman RM (1985) Human eye movements associated with blinks and prolonged eyelid closure. J Neurophysiol 54:11–27

    Google Scholar 

  13. Cramon D von (1980) Die bilateralen vaskulären Thalamus-Syndrome. Münch Med Wochenschr 122:1385–1386

    Google Scholar 

  14. Cramon D von, Kühnlein J, Wolfram A (1981) Die thalamische Demenz. Fortschr Neurol Psychiatr 49:129–135

    Google Scholar 

  15. Davis PH, Bergeron C, McLachlan DR (1985) Atypical presentation of progressive supranuclear palsy. Ann Neurol 17:337–343

    Google Scholar 

  16. Denny-Brown D (1977) Spasm of visual fixation. In: Rose FC (ed) Physiological aspects of clinical neurology. Blackwell, Oxford, pp 43–75

    Google Scholar 

  17. Denny-Brown D, Fischer EG (1976) Physiological aspects of visual perception. Arch Neurol 33:228–241

    Google Scholar 

  18. Dieterich M, Brandt T (1987) Impaired motion perception in congenital nystagmus and acquired ocular motor palsy. Clin Vis Sci 1:337–345

    Google Scholar 

  19. Finney DJ (1971) Probit analysis. Cambridge University Press, Cambridge, England

    Google Scholar 

  20. Fukushima K (1987) The interstitial nucleus of cajal and its role in the control of movements of head and eyes. Prog Neurobiol 29:107–192

    Google Scholar 

  21. Graff-Radford NR, Damasio H, Yamada T, Eslinger PJ, Damasio AR (1985) Non-haemorrhagic thalamic infarction: clinical, neuropsychological and electrophysiological findings in four anatomical groups defined by computerized tomography. Brain 108:485–516

    Google Scholar 

  22. Halmagyi GM, Evans WA, Hallinan JM (1978) Failure of downward gaze. Arch Neurol 35:22–26

    Google Scholar 

  23. Harting JK, Huerta M, Frankfurter A, Strominger L, Royce GJ (1980) Ascending pathways from the monkey superior colliculus: an autoradiographic analysis. J Comp Neurol 192:853–882

    Google Scholar 

  24. Hassler R (1972) Supranuclear structures regulating binocular eye and head movements. Bibl Ophthalmol 82:207–219

    Google Scholar 

  25. Hepp K, Henn V, Vilis T, Cohen B (1989) Brainstem regions related to saccade generation. In: Wurtz RH, Goldberg ME (eds) The neurobiology of saccadic eye movements. Rev Oculomotor Res 3:105–212

    Google Scholar 

  26. Hess WR, Rürgis S, Bucher V (1946) Motorische Funktion des tektalen und tegmentalen Gebietes. Monatsschr Psychiatr Neurol 112:1–52

    Google Scholar 

  27. Highstein SM, Moschovakis AK, Warren JD (1986) Morphophysiology of vertical medium-lead burst neurons in the alert squirrel monkey (abstract). Soc Neurosci 12:1186

    Google Scholar 

  28. Jacobs L, Anderson P, Bender MB (1973) The lesions producing paralysis of downward but not upward gaze. Arch Neurol 28:319–323

    Google Scholar 

  29. Jacobs L, Heffner RR, Newman RP (1985) Selective paralysis of downward gaze caused by bilateral lesions of the mesencephalic periaqueductal grey matter. Neurology 35:516–521

    Google Scholar 

  30. Kinchla RA, Allan LG (1970) Visual movement perception: a comparison of sensitivity to vertical and horizontal movement. Percept Psychophysiol 8:399–405

    Google Scholar 

  31. King WM, Fuchs AF (1979) Reticular control of vertical saccadic eye movements by mesencephalic burst neurons. J Neurophysiol 42:861–876

    Google Scholar 

  32. King WM, Fuchs AF, Magnin M (1981) Vertical eye movement-related responses of neurons in midbrain near interstitial nucleus of Cajal. J Neurophysiol 46:549–562

    Google Scholar 

  33. Kobari M, Ishihara N, Yunoki K (1987) Bilateral thalamic infarction associated with selective downward gaze paralysis. Eur Neurol 26:246–251

    Google Scholar 

  34. Kömpf D, Pasik T, Pasik P, Bender MB (1979) Downward gaze in monkeys: stimulation and lesion studies. Brain 102:527–558

    Google Scholar 

  35. Kömpf D, Oppermann J, König F, Talmon-Gros S, Babaian E (1984) Vertikale Blickparese und thalamische Demenz. Nervenarzt 55:625–636

    Google Scholar 

  36. Komatsu H, Suzuki H (1985) Projections from the functional subdivisions of the frontal eye fields to the superior colliculus in the monkey. Brain Res 327:324–327

    Google Scholar 

  37. Maunsell JHR, Essen DC van (1983) The connections of the middle temporal visual area (MT) and their relationship to a cortical hierarchy in the macaque monkey. J Neurosci 3:2563–2586

    Google Scholar 

  38. Meissner J, Sapir S, Kokmen E, Stein SD (1987) The paramedian diencephalic syndrome: a dynamic phenomenon. Stroke 18:380–385

    Google Scholar 

  39. Mills RP, Swanson PD (1978) Vertical oculomotor apraxia and memory loss. Ann Neurol 4:149–153

    Google Scholar 

  40. Mizutani T, Satoh J, Morimatsu Y (1985) Clinicopathological study on eye movement of progressive supranuclear palsy. Clin Neuropathol 25:355–363

    Google Scholar 

  41. Monnier M (1946) Les formations reticulée tegmentales; équilibration des postures du regard de la tête et du tronc. Rev Neurol (Paris) 78:422–452

    Google Scholar 

  42. Muskens LJJ (1934) Das supravestibuläre System bei den Tieren und beim Menschen, mit besonderer Berücksichtigung der Blicklähmungen, der sogenannten Stammhirnataxie, der Zwangsstellungen und der Zwangsbewegungen. North-Holland, Amsterdam, pp 244–255

    Google Scholar 

  43. Oppelt A, Graumann R, Barfuss H, Fischer H, Hartl W, Schajar W (1986) FISP — a new fast MRI sequence. Electromedica 54:1–4

    Google Scholar 

  44. Pasik P, Pasik T, Bender MB (1969) The pretectal syndrome in monkeys. I. Disturbances of gaze and body posture. Brain 92:521–534

    Google Scholar 

  45. Percheron G (1973) The anatomy of the arterial supply of the human thalamus and its use for the interpretation of the thalamic vascular supply. Z Neurol 20:1–13

    Google Scholar 

  46. Percheron G (1976) Les artères du thalamus humain. Artères thalamiques paramédians de l'artère basilaire communicante. Rev Neurol (Paris) 132:309–324

    Google Scholar 

  47. Petit H, Rousseaux M, Clarisse J, Delafosse A (1981) Troubles oculo-céphalomoteurs et infarctus thalamo-sous-thalamique bilatéral. Rev Neurol (Paris) 11:709–722

    Google Scholar 

  48. Pierrot-Deseilligny, Chain F, Gray F, Serdaru M, Escourolle R, Lhermitte F (1982) Parinaud's syndrome: electro-oculographic and anatomical analyses of six vascular cases with deductions about vertical gaze organization in the premotor structures. Brain 105:667–696

    Google Scholar 

  49. Pierrot-Deseilligny C, Gray F, Brunet P (1986) Infarcts of both inferior parietal lobules with impairment of visually guided eye movements, peripheral visual inattention and optic ataxia. Brain 109:81–97

    Google Scholar 

  50. Ranalli PJ, Sharpe JA, Fletcher WA (1988) Palsy of upward and downward saccadic, pursuit, and vestibular movements with a unilateral midbrain lesion: pathophysiologic correlations. Neurology 38:114–122

    Google Scholar 

  51. Robinson DA (1963) A method of measuring eye movements using a scleral search coil in a magnetic field. IEEE Trans Biomed Electron 10:137–145

    Google Scholar 

  52. Rousseaux M, Petit H, Hache JC, Devos PH, Dubois F, Warot P (1985) La motricité oculaire et céphalique dans les infarctus de la region thalamique. Rev Neurol (Paris) 5:391–403

    Google Scholar 

  53. Schlesinger B (1976) The upper brainstem in the human. Springer, Berlin Heidelberg New York

    Google Scholar 

  54. Schuster P (1921) Zur Pathologie der vertikalen Blicklähmung. Dtsch Nervenheilkd 70:97–115

    Google Scholar 

  55. Segarra JM (1970) Cerebral vascular disease and behavior. I. The syndrome of the mesencephalic artery (basilar artery bifurcation). Arch Neurol 22:408–418

    Google Scholar 

  56. Trojanowski JQ, Wray SH (1980) Vertical gaze ophthalmoplegia: selective paralysis of downgaze. Neurology 30:605–610

    Google Scholar 

  57. Weber JT, Yin TCT (1984) Subcortical projections of the inferior parietal cortex (area 7) in the stump-tailed monkey. J Comp Neurol 224:206–230

    Google Scholar 

  58. Weder B, Meienberg O (1983) Downgaze paralysis due to brainstem infarction. Neuroophthalmology 3:29–35

    Google Scholar 

  59. Westheimer G (1954) Eye movement responses to a horizontally moving visual stimulus. Arch Ophthalmol 52:932–941

    Google Scholar 

  60. Zee DS, Chu FC, Leigh J, Savino PJ, Schatz NJ, Reingold DB, Cogan DG (1983) Blink-saccade synkinesis. Neurology 33:1233–1236

    Google Scholar 

  61. Zuk A, Gwyn DG, Rutherford JG (1982) Cytoarchitecture, neuronal morphology and some efferent connections of the interstitial nucleus of Cajal (INC) in the cat. J Comp Neurol 212:278–292

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, University of Tübingen, Hoppe-Seyler-Strasse 3, W-7400, Tübingen, Federal Republic of Germany

    W. Heide, E. Koenig & J. Dichgans

  2. Department of Neuro-ophthalmology, University of Tübingen, Hoppe-Seyler-Strasse 3, W-7400, Tübingen, Federal Republic of Germany

    M. Fahle

  3. Department of Neuroradiology, University of Tübingen, Hoppe-Seyler-Strasse 3, W-7400, Tübingen, Federal Republic of Germany

    G. Schroth

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Heide, W., Fahle, M., Koenig, E. et al. Impairment of vertical motion detection and downgaze palsy due to rostral midbrain infarction. J Neurol 237, 432–440 (1990). https://doi.org/10.1007/BF00314736

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