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An unusual variant of the dorsal midbrain syndrome in MS: clinical characteristics and pathophysiologic mechanismsDepartment of Neurology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA, elliot.frohman{at}utsouthwestern.edu
Department of Neurology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
Department of Neurology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA Patients with MS exhibit a broad diversity of ocular motor syndromes. We describe a patient with relapsing-remitting MS who developed an unusual variation of the dorsal midbrain syndrome, character ized by monocular convergent-retraction nystagmus in the right eye, accompanied by divergent-retraction nystagmus in the fellow eye upon attempted upward gaze. Examination also revealed a skew deviation with a left hyperdeviation and severe adductio n limitation in the left eye during attempted right gaze. We propose that a left INO accounted for the inability of the left eye to adduct (and result in convergent-retraction) during attempted upward saccades. We consider the patho physiologic mechanisms responsible for our observations and review important details of the dorsal midbrain ocular motor circuitr y.
Key Words: convergent retraction nystagmus • dorsal midbrain • skew deviation
Multiple Sclerosis, Vol. 10, No. 3,
322-325 (2004) This article has been cited by other articles:
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