Tonic ocular tilt reaction in the caudal pontine lesions.
- Author:
Phil Hyu LEE
1
;
Jong Sam BAIK
;
Sang Won HAN
;
Young Ho SOHN
Author Information
1. Department of Neurology, Yonsei University College of Medicine.
- Publication Type:Original Article
- MeSH:
Aged;
Brain Stem;
Cerebellum;
Female;
Hand;
Head;
Humans;
Infarction;
Magnetic Resonance Imaging;
Mesencephalon;
Middle Aged;
Pica;
Pons;
Vestibular Nuclei;
Zea mays
- From:Journal of the Korean Neurological Association
1997;15(4):907-914
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
The ocular tilt reaction (OTR) represents a fundamental pattern of eye hand coordination in roll plane and consists of head tilt, conjugate eye torsion, hypotropia, all toward the same side. OTR can be observed not only in patients with peripheral vestibular dysfucntion but also in these with lesions of the graviceptive pathway, which runs from the vestibular nuclei, crossing the midline at the caudal pons, to the intersititial nucleus of Cajal in the rostral midbrain. We present two patients showed complete OTR with the caudal pontine lesions. The first patient was a 65-year-old woman and the lesions involved the dorsolateral portion of pontomedullary junction and cerebellum which was corn patible with AICA and PICA territorial infarction, a magnetic resonanse image(MRI). The ipsiversive OTR in the first patient might be secondary to the ipsilateral vestibular nuclear lesion. The second patient was a 60 year old man and revealed the infarctions in tegmental portion of caudal pons and cerebellum on MRI. The contraversive OTR in the second patient may be secondary to the pontine tegmental lesion involving medial longitudinal fasciculus which is a structure responsible for ascending crossed contralateral graviceptive pathway. OTR is a sensitive brainstem sign of lateralizing and localizing value and our presenting cases support that OTR represents vestibular tone imbalance in the graviceptive pathways.
