Midbrain lesion-induced disconjugate gaze: a unifying circuit mechanism of ocular alignment?

Autor: Friedrich MU; Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, 60 Fenwood Rd, Boston, MA, 02115, USA.; Harvard Medical School, Boston, USA., Schappe L; Department of Neurology, Saarland University Medical Center, Homburg, Germany. Laurin.Schappe@uks.eu., Prasad S; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Pennsylvania, USA., Friedrich H; Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, 60 Fenwood Rd, Boston, MA, 02115, USA., Fox MD; Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, 60 Fenwood Rd, Boston, MA, 02115, USA.; Harvard Medical School, Boston, USA., Zwergal A; German Center for Vertigo and Dizziness, University Hospital, LMU Munich, Munich, Germany.; Department of Neurology, University Hospital, LMU Munich, Munich, Germany., Zee DS; Departments of Neurology, Ophthalmology, Otolaryngology, Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, USA., Faßbender K; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Pennsylvania, USA., Dillmann KU; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Pennsylvania, USA.
Jazyk: angličtina
Zdroj: Journal of neurology [J Neurol] 2024 May; Vol. 271 (5), pp. 2844-2849. Date of Electronic Publication: 2024 Feb 14.
DOI: 10.1007/s00415-023-12155-6
Abstrakt: Background: Disconjugate eye movements are essential for depth perception in frontal-eyed species, but their underlying neural substrates are largely unknown. Lesions in the midbrain can cause disconjugate eye movements. While vertically disconjugate eye movements have been linked to defective visuo-vestibular integration, the pathophysiology and neuroanatomy of horizontally disconjugate eye movements remains elusive.
Methods: A patient with a solitary focal midbrain lesion was examined using detailed clinical ocular motor assessments, binocular videooculography and diffusion-weighted MRI, which was co-registered to a high-resolution cytoarchitectonic MR-atlas.
Results: The patient exhibited both vertically and horizontally disconjugate eye alignment and nystagmus. Binocular videooculography showed a strong correlation of vertical and horizontal oscillations during fixation but not in darkness. Oscillation intensities and waveforms were modulated by fixation, illumination, and gaze position, suggesting shared visual- and vestibular-related mechanisms. The lesion was mapped to a functionally ill-defined area of the dorsal midbrain, adjacent to the posterior commissure and sparing nuclei with known roles in vertical gaze control.
Conclusion: A circumscribed region in the dorsal midbrain appears to be a key node for disconjugate eye movements in both vertical and horizontal planes. Lesioning this area produces a unique ocular motor syndrome mirroring hallmarks of developmental strabismus and nystagmus. Further circuit-level studies could offer pivotal insights into shared pathomechanisms of acquired and developmental disorders affecting eye alignment.
(© 2024. The Author(s).)
Databáze: MEDLINE
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