Unilateral INO is associated with ocular tilt reaction in pontomesencephalic lesions - INO plus
Unilateral INO is associated with ocular tilt reaction in pontomesencephalic lesions - INO plus
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DOI：
10.1212/01.wnl.0000323814.72216.48
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发表时间：
2008-08-19
期刊：
影响因子：
9.9
通讯作者：
Strupp, M.
中科院分区：
文献类型：
--
作者：
Zwergal, A.;Cnyrim, C.;Strupp, M.
目的：核间性眼肌麻痹 (INO) 与眼倾斜反应 (OTR) 成分的相关性，以便定位脑干中的重力感受（特别是耳石）通路。方法：我们回顾性分析了 120 名 INO 患者（87 名单侧 [其中 9 名患有一半综合征]，33 名双侧）的 OTR（主观视觉垂直 [SVV]、眼扭转、结果：单侧 INO 至少伴有 OTR 的一个组成部分：96% 为 SVV 倾斜，79% 为眼扭转，50% 为偏斜。所有组件均指向对侧。 89% 的一岁半综合征患者发生对侧 OTR。只有 9% 的双侧 INO 患者表现出 OTR。 MRI 显示 68% 的患者有明显的病变，几乎完全投射到脑桥中脑内侧纵束 (96%)。后续测量显示 SVV 和眼扭转正常化速度快于 INO 内收缺陷。结论：首先，单侧核间性眼肌麻痹 (INO) 通常与逆眼倾斜反应 (OTR) 相关：INO 加。因此，重力感受通路在穿过前庭核和外展核之后加入内侧纵束。其次，OTR 成分和 INO 体征恢复的不同时间进程和程度可以通过这样的假设来解释：前庭音调不平衡由中枢前庭适应机制（可能主要由小脑前庭投射驱动）补偿，而内收受损根据赫林定律不太容易受到补偿，只能通过病变修复来克服。第三，双侧 INO 很少与 OTR 相关，这证实了重力感受通路的双侧损伤不会导致滚动平面的不平衡。
Objective: Correlation of internuclear ophthalmoplegia (INO) with components of the ocular tilt reaction (OTR) in order to localize graviceptive (specifically otolithic) pathways in the brainstem.Methods: We retrospectively analyzed data of 120 patients with INO (87 unilateral [9 of whom had one-and-a-half syndrome], 33 bilateral) for OTR (subjective visual vertical [SVV], ocular torsion, skew deviation) to localize causative brainstem lesions in MRI.Results: Unilateral INO was accompanied by at least one component of OTR: SVV tilt in 96%, ocular torsion in 79%, and skew deviation in 50%. All components were directed to the contralesional side. Contralateral OTR occurred in 89% of patients with one-and-a-half syndrome. Only 9% of patients with bilateral INO exhibited OTR. MRI showed distinct lesions in 68%, which almost exclusively projected onto the pontomesencephalic medial longitudinal fascicle (96%). Follow-up measurements revealed SVV and ocular torsion normalized faster than the adduction deficit in INO.Conclusions: First, unilateral internuclear ophthalmoplegia (INO) is regularly associated with contraversive ocular tilt reaction (OTR): INO plus. Thus, graviceptive pathways join the medial longitudinal fascicle after crossing between the vestibular and abducens nuclei. Second, the different time course and degree of recovery of OTR components and INO signs can be explained by the hypothesis that vestibular tone imbalance is compensated by central vestibular adaptation mechanisms (probably driven mainly by cerebellar-vestibular projections), whereas impaired adduction is less susceptible to compensation according to Hering's law and can only be overcome by lesion repair. Third, bilateral INO is seldom associated with OTR, confirming that bilateral impairment of graviceptive pathways does not cause imbalance in roll plane.