Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0028738 (nystagmus)
 7,431 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors report a woman aged 53 years with the main components of the syndrome of Opalski coexisting with signs characteristic of Wallenberg's syndrome. The lacking components of the former syndrome included Horner's syndrome, while nystagmus, diplopia without evident oculomotor nerves, paresis, disturbances of speech and deglutition belonged to the latter syndrome. The clinical pattern and the course of the disease suggested a vasogenic focus in the right submedullary region and inferolateral part of the medulla.
 ...
PMID:[Atypical Opalski's syndrome]. 72 53

Eighteen patients with Wallenberg's syndrome were investigated concerning visually induced eye movements. All results were analysed quantitatively using a computer. In 16 out of 18 patients, OKN slow-phase velocities were impaired, in the remaining 2 patients they were normal. Patients who showed impaired OKN were classified into two groups according to directional asymmetry of OKN impairment. In 7 out of the 16 patients, slow-phases toward the lesion side were predominantly impaired in contrast to the slow-phases toward the intact side (group A). In the remaining 9 patients, slow-phases toward the intact side were predominantly impaired (group B). The smooth pursuit showed the same asymmetry as the OKN slow-phase, except, in 4 patients who showed normal smooth pursuit. All patients showed reduced visual suppression of caloric nystagmus during the slow-phase of nystagmus toward the lesion side, except 3 patients who showed normal visual suppression in both directions. CT scan failed to detect either the brainstem or the cerebellar lesions in any cases, but MRI performed on the most recent cases demonstrated the infarctions clearly. These findings suggest that infarctions are localized in the medulla in the patients of group A, but extend to the cerebellum as well as to the medulla in patients of group B.
 ...
PMID:Visually induced eye movements in Wallenberg's syndrome. 192 70

Transient and lasting oculomotor disturbances during visual-vestibular interaction are described in 9 patients with Wallenberg's lateral medullary syndrome. In all patients magnetic resonance imaging (MRI) demonstrated a single focal area of pathological signal intensity in the (dorso)-lateral medulla suggesting infarction. In 2 of these 9 patients and in 3 further patients with no medullary signs, the infarction involved the cerebellar territory of the posterior inferior cerebellar artery (PICA). Acutely, all patients with Wallenberg's syndrome (except 1) had saccadic lateropulsion and spontaneous nystagmus in light with the horizontal fast component beating to the contralateral normal side. The velocity of the slow drift to the side of the lesion was dependent on eye position and induced a characteristic asymmetry of the visually and vestibularly elicited slow eye movements. In most patients smooth pursuit, optokinetic nystagmus and visual suppression of the vestibulo-ocular reflex were still impaired when this spontaneous drift was minimal or absent. The oculomotor disturbances in patients with and without cerebellar infarction are compared. The following conclusions are made. (1) The spontaneous drift that is dependent on eye position is mostly created by 'ocular lateropulsion', that is, a tonic bias within the oculomotor system which may have several sources. (2) The abnormalities and asymmetries of oculomotor responses during visual-vestibular stimulation cannot solely be explained by this spontaneous drift and its interaction with otherwise normal eye movements. Instead, structures and pathways are damaged in Wallenberg's syndrome which mediate visual and/or motor signals important for the cerebellar control of visually-guided slow eye movements. (3) Damage to these pathways occurs in the lateral medulla, as the MRI findings show that in most patients the cerebellum is rarely involved, but no definite conclusion can be made as to which of the fibres travelling in the inferior peduncle to the cerebellum may be interrupted.
 ...
PMID:Oculomotor disturbances during visual-vestibular interaction in Wallenberg's lateral medullary syndrome. 236 71

To determine the diagnostic value of visually-induced eye movements for indicating the lateralization of the lesion, optokinetic nystagmus (OKN), fixation-suppression of caloric nystagmus and pursuit eye movements were investigated in 28 patients who showed discrete unilateral brainstem lesions. In all patients, pursuit gains decreased in parallel with the direction of the impairment of slow-phase OKN velocity with a significant left/right difference. Decreases of gains were predominantly towards the affected side in 22 patients, whereas they were predominantly towards the contralateral side in 2 patients with dorsal tegmental pontine lesions and in 4 out of 8 patients with Wallenberg's syndrome. The relationship of pursuit gains to percentage reduction of fixation-suppression of caloric nystagmus (%FS) showed no correlation. The following four groups were classified. In group A, which was the largest, pursuit gains and %FS decreased predominantly towards the lesioned side. This group consisted of 5 patients with lesions in the midbrain, 6 patients with lesions in the ventral pons and 4 out of 8 patients with Wallenberg's syndrome. The opposite of group A was group D, showing reverse electro-oculographic (EOG) patterns to those in group A in relation to the lesioned side. Group D consisted of 2 patients with lesions in the dorsal pontine tegmentum. This observation, taken together with the decreases of pursuit and OKN gains in relation to the lesioned side, might indicate that lesions of ascending fibres are responsible for pursuit and OKN abnormalities. Group B, consisting of 7 patients with lesions either in the superior or middle cerebellar peduncles, showed decreased pursuit gains predominantly towards the lesioned side and %FS reduced predominantly towards the side contralateral to the lesion. EOGs of these patients were consistent with the results of floccular ablation in the monkey. In group C, these two parameters showed patterns opposite to those in group B in relation to the lesioned side and this group consisted of the other 4 patients with Wallenberg's syndrome. In patients of this group, the inferior cerebellar peduncle might be involved. The combined use of these tests is thus useful for lateralizing the lesion in the brainstem.
 ...
PMID:Mapping of brainstem lesions by the combined use of tests of visually-induced eye movements. 239 92

An elderly woman with the persistent isolated symptom of monocular and binocular tilting of environmental objects, was found on magnetic resonance imaging to have compression of the lateral medulla by an ectatic vertebral artery. The double Maddox rod test showed no relative torsion of either globe although 5 degrees of right excyclotorsion and left incyclotorsion (rightward ocular counter-rolling) was detected on testing with monocular viewing. There was no accompanying hyperdeviation, nystagmus or other neurologic signs. Symmetrical tilting of each globe associated with head tilt and skew deviation (the ocular tilt reflex) may be caused by lesions involving otolith connections. Isolated environmental tilt may herald the onset of lateral medullary infarction (Wallenberg's syndrome), or may be associated with vertebro-basilar insufficiency. Could compression of otolith connections in the medulla cause persistent ocular counter-rolling without accompanying neurologic signs?
 ...
PMID:Isolated environmental tilt associated with lateral medullary compression by dolichoectasia of the vertebral artery. Is there a cause and effect relationship? 295 77

A 63-year-old Caucasian man was admitted for Wallenberg's syndrome following a left vertebral artery thrombosis. In addition to the classical symptoms, an axial lateropulsion to the left and ocular motor disorders (vertical diplopia, tonic deviation of the gaze to the left, skew deviation and horizonto-rotatory nystagmus) were present. These clinical signs are unusual, but in common Wallenberg's syndrome, neurophysiological tests often reveal slight abnormalities of oculomotor function: impairment of jerks, skew deviation, lateral deviation of the gaze in darkness. Interruption of cerebellar pathways is thought to be the cause of these symptoms. Their existence does not seem to change the outcome of these cases.
 ...
PMID:Lateral gaze disturbance in a case of Wallenberg's syndrome. 383 Feb 9

We studied electro-oculographic and videotape recordings of eye movements in six patients with Wallenberg's syndrome. With fixation, all patients had a spontaneous rotatory nystagmus with the fast phase directed toward the intact side. With loss of fixation, the patients' eyes deviated tonically toward the side of the lesion. Voluntary and involuntary saccades had larger amplitude when directed toward the side of the lesion than away from it. The spontaneous nystagmus predictably interacted with all slow eye movements, producing asymmetric smooth-pursuit, optokinetic, and vestibular responses. In addition, smooth-pursuit and optokinetic responses were decreased significantly in both directions compared to normal subjects. Fixation suppression of vestibular nystagmus also was impaired in both directions. We concluded that two different types of oculomotor bias were present in these patients--a velocity bias and a position bias. The former resulted from damage to the caudal lateral vestibular nuclei, and the latter from interruption of cerebellopontine pathways.
 ...
PMID:Eye movements in patients with Wallenberg's syndrome. 697 48

Eleven cases presenting a syndrome of the medulla oblongata are discussed with reference to the findings of clinical and angiographic investigation. The diagnosis of Wallenberg's syndrome is justified when the classic symptoms are apparent (Horner's syndrome, nystagmus, dysphonia and dysphagia, ataxia, ipsilateral sensory impairment of the face and contralateral elsewhere, and accompanying vegetative disturbances). If additional symptoms such as a facial or extra-ocular muscle paresis, especially hemiparesis, exist, another, more lateral or medial, syndrome of the oblongata should be considered. Angiographic findings vary considerably, ranging from a normal vertebral artery or posterior inferior cerebellar artery (PICA) to an occlusion of these arteries (in three and two of the 11 cases respectively). Modification are often seen in the anterior inferior cerebellar artery (AICA). A kind of complementary supply in the PICA-AICA region must occasionally exist. Localised processes affecting these vessels rather than diffuse multifocal vascular processes would lead to Wallenberg's syndrome. It is difficult to conclude from the clinical picture where a possible responsible vascular narrowing or obliteration may lie, even if pareses of the limb were present.
 ...
PMID:[Clinical and angiographic findings in vascular medullary syndromes (author's transl)]. 731 26

To determine the lesions and the lateralization in patients with Wallenberg's syndrome, visually-guided eye movements were quantitatively analysed and these findings were compared with a lesioned site as revealed by magnetic resonance imaging (MRI). The 8 patients could be clearly classified into two subgroups based on the functional test of eye movements. In 4 patients, optokinetic nystagmus (OKN), pursuit eye movements and fixation-suppression of caloric nystagmus (FS), utilizing the slow phase velocity as a parameter, were impaired toward the lesioned side in the medulla. In the remaining 4 patients, OKN and pursuit eye movements were impaired toward the side contralateral to the lesion, whereas FS toward the lesioned side, indicating a lesion affecting not only the medulla but also the inferior peduncle and/or the cerebellum. Therefore, the functional visually-guided eye movements can provide a useful test battery with which to detect the lesion site in Wallenberg's syndrome.
 ...
PMID:Visually guided eye movements in patients with Wallenberg's syndrome. 761 Aug 49

Vestibular dysfunction is a significant differential diagnosis in patients who have unexpected falls without: loss of consciousness, paresis, sensory loss, or cerebellar deficit. Either peripheral or central vestibular disorders cause postural instability with preferred directions of falling, some of which can be attributed to either the particular plane of the affected semicircular canal or a central pathway mediating the 3-dimensional vestibulo-ocular reflex in yaw, pitch, and roll. Ipsiversive falls occur in vestibular neuritis or in Wallenberg's syndrome--where they are known as lateropulsion. Contraversive falls are typical for the otolith Tullio phenomenon, vestibular epilepsy, and thalamic astasia. Predominant fore-aft instability is observed in bilateral vestibulopathy, benign paroxysmal positioning vertigo, as well as in downbeat or upbeat nystagmus syndrome. Falls can be diagonally forward (or backward) and toward or away from the side of the lesion, depending on the site of the lesion (the ocular tilt reaction is ipsiversive in medullary lesions, but contraversive in mesencephalic lesions) and on whether vestibular structures are excited or inhibited.
 ...
PMID:Vestibular falls. 827 42


1 2 Next >>