Upbeat-torsional nystagmus and contralateral fourth-nerve palsy due to unilateral dorsal ponto mesencephalic lesion

Matthew J Thurtell; Robert L Tomsak; R John Leigh

doi:10.1111/j.1749-6632.2008.03713.x

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Upbeat-torsional nystagmus and contralateral fourth-nerve palsy due to unilateral dorsal ponto mesencephalic lesion

Journal article

Peer reviewed

Upbeat-torsional nystagmus and contralateral fourth-nerve palsy due to unilateral dorsal ponto mesencephalic lesion

Matthew J Thurtell, Robert L Tomsak and R John Leigh

Annals of the New York Academy of Sciences, Vol.1164(1), pp.476-478

05/2009

DOI: 10.1111/j.1749-6632.2008.03713.x

PMCID: PMC2866066

PMID: 19645952

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http://doi.org/10.1111/j.1749-6632.2008.03713.xView

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Abstract

The central projections of the anterior semicircular canals are thought to be conveyed from the vestibular nuclei to the oculomotor nuclei in the midbrain by three distinct brainstem pathways: the medial longitudinal fasciculus, crossing ventral tegmental tract, and brachium conjunctivum. There is controversy as to whether upbeat nystagmus could result from lesions involving each of these pathways. We report a 52-year-old man who presented with a contralesional fourth-nerve palsy and primary-position upbeat-torsional nystagmus due to a small unilateral dorsal pontomesencephalic lymphomatous deposit. It is postulated that the upbeat-torsional nystagmus was caused by involvement of the brachium conjunctivum, which lies adjacent to the fourth-nerve fascicles at the dorsal pontomesencephalic junction, but involvement of the crossing ventral tegmental tract cannot be excluded. These observations suggest that, in humans, excitatory upward-torsional eye movement signals from the anterior semicircular canals could be partly conveyed to the midbrain by the brachium conjunctivum.

Magnetic Resonance Imaging

Trochlear Nerve Diseases - complications

Nystagmus, Pathologic - complications

Nystagmus, Pathologic - diagnosis

Humans

Middle Aged

Male

Trochlear Nerve Diseases - diagnosis

Mesencephalon - pathology

Details

Title: Subtitle: Upbeat-torsional nystagmus and contralateral fourth-nerve palsy due to unilateral dorsal ponto mesencephalic lesion
Creators: Matthew J Thurtell - Department of Neurology, University Hospitals Case Medical Center, Cleveland, Ohio, USA. mj.thurtell@gmail.com
Robert L Tomsak
R John Leigh
Resource Type: Journal article
Publication Details: Annals of the New York Academy of Sciences, Vol.1164(1), pp.476-478
DOI: 10.1111/j.1749-6632.2008.03713.x
PMID: 19645952
PMCID: PMC2866066
NLM abbreviation: Ann N Y Acad Sci
ISSN: 0077-8923
eISSN: 1749-6632
Publisher: United States
Grant note: R01 EY006717-22 / NEI NIH HHS R01 EY006717 / NEI NIH HHS EY06717 / NEI NIH HHS
Language: English
Date published: 05/2009
Academic Unit: Neurology; Ophthalmology and Visual Sciences
Record Identifier: 9983980297602771

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