Brain, Vol. 110, No. 3, 649-666, 1987
© 1987 Guarantors of Brain
research-article |
PATHOLOGICAL EYE-HEAD COORDINATION IN ROLL: TONIC OCULAR TILT REACTION IN MESENCEPHALIC AND MEDULLARY LESIONS
From the Neurological Clinic, Klinikum Grosshadern, University of Munich Federal Republic of Germany
Correspondence to:
Correspondence to: Professor Thomas Brandt, Neurological Clinic, Klinikum Grosshadern, University of Munich, Marchioninistrasse 15, D 8000 Munich 70, FRG.
The fundamental pattern of coordinated eye-head roll motion is based upon utricular/saccular as well as vertical canal input, and mediated by the graviceptive pathways from the labyrinths via pontomedullary vestibular nuclei to the rostral midbrain tegmentum. The tonic bilateral graviceptive input stabilizes the eyes and head in the normal upright position. A unilateral lesion causes imbalance in vestibular tone in the roll plane which results in a tonic ipsiversive ocular tilt reaction (OTR).
OTR, the triad of ipsilateral head tilt, skew deviation and ocular torsion, occurred as a tonic response (nonparoxysmal) persisting over months to years and was presumed to be due to upper brainstem lesions in 3 patients. Precise localization was limited because of the nature of the lesions. A reversible tonic OTR was seen with acute infarction of the dorsolateral medulla oblongata in 4 out of 11 patients. It may be explained by an ipsilateral lesion of the posterior canal pathways. Transient OTR seems not to be rare in acute Wallenberg's syndrome and ocular torsion in these patients is dysconjugate with predominant excyclotropia of the ipsilateral hypotropic eye. A deviation of the subjective visual vertical in the direction of the spontaneous head tilt—a previously undescribed feature of OTR—was present in all 7 patients and indicates a pathological shift of the internal representation of the gravitational vector. With respect to perception (subjective vertical) it is proposed that the manifest ipsiversive OTR represents a motor compensation of an apparent eye-head tilt contraversive to the lesioned side. Despite the resulting postural imbalance and the conflicting true vertical of the visual surround, the eyes, head and body are continuously adjusted to what the central nervous system erroneously computes as being vertical.
Received January 28, 1986. Revised June 17, 1986. Accepted June 26, 1986.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Schlenker, G. Mirabella, H. C. Goltz, P. Kessler, A. W. Blakeman, and A. M. F. Wong The Linear Vestibulo-Ocular Reflex in Patients with Skew Deviation Invest. Ophthalmol. Vis. Sci., January 1, 2009; 50(1): 168 - 174. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C. Brodsky Vertical Strabismus: Diagnosis From the Ground Up Arch Ophthalmol, July 1, 2008; 126(7): 992 - 993. [Full Text] [PDF]
|
|
|
|
|
|
M. Fesharaki, P. Karagiannis, D. Tweed, J. A. Sharpe, and A. M. F. Wong Adaptive Neural Mechanism for Listing's Law Revealed in Patients with Skew Deviation Caused by Brainstem or Cerebellar Lesion Invest. Ophthalmol. Vis. Sci., January 1, 2008; 49(1): 204 - 214. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H Rambold and C Helmchen Spontaneous nystagmus in dorsolateral medullary infarction indicates vestibular semicircular canal imbalance J. Neurol. Neurosurg. Psychiatry, January 1, 2005; 76(1): 88 - 94. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M C Brodsky Three dimensions of skew deviation Br J Ophthalmol, December 1, 2003; 87(12): 1440 - 1441. [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Bronstein, D. A. Perennou, M. Guerraz, D. Playford, and P. Rudge Dissociation of visual and haptic vertical in two patients with vestibular nuclear lesions Neurology, November 11, 2003; 61(9): 1260 - 1262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A Radtke, A M Bronstein, M A Gresty, M Faldon, W Taylor, J M Stevens, and P Rudge Paroxysmal alternating skew deviation and nystagmus after partial destruction of the uvula J. Neurol. Neurosurg. Psychiatry, June 1, 2001; 70(6): 790 - 793. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. A. Kori, A. Schmid-Priscoveanu, and D. Straumann Vertical Divergence and Counterroll Eye Movements Evoked by Whole-Body Position Steps About the Roll Axis of the Head in Humans J Neurophysiol, February 1, 2001; 85(2): 671 - 678. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C. Brodsky Dissociated Vertical Divergence: A Righting Reflex Gone Wrong Arch Ophthalmol, September 1, 1999; 117(9): 1216 - 1222. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. P. Donahue, P. J. M. Lavin, and L. M. Hamed Tonic Ocular Tilt Reaction Simulating a Superior Oblique Palsy: Diagnostic Confusion With the 3-Step Test Arch Ophthalmol, March 1, 1999; 117(3): 347 - 352. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Ouchi, H. Okada, E. Yoshikawa, S. Nobezawa, and M. Futatsubashi Brain activation during maintenance of standing postures in humans Brain, February 1, 1999; 122(2): 329 - 338. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. F. Mehler The Neuro-ophthalmologic Spectrum of the Rostral Basilar Artery Syndrome Arch Neurol, September 1, 1988; 45(9): 966 - 971. [Abstract] [PDF]
|
|