Teaching Video NeuroImages: Unilateral RIMLF lesion
Pathologic eye movement torsion indicates lesion side and site
O. Kremmyda, MD, PhD,
N. Rettinger,
M. Strupp, MD,
U. Büttner, MD and
S. Glasauer, PhD
From the Department of Neurology, Klinikum Grosshadern, Munich, Germany.
Address correspondence and reprint requests to Dr. Olympia Kremmyda, Neurologisches Forschungshaus, Marchioninistr. 23, 81377 Munich, Germany olkrem{at}yahoo.com
A 45-year-old woman presented with acute vertigo and a verticalgaze palsy. Examination with Frenzel goggles showed that duringvertical saccades the eyes were torsionally deviating to theleft (counterclockwise from the patient's point of view) andslowly returned to the initial zero torsion after the saccade(video on the Neurology® Web site at www.neurology.org;figure 1). This eye movement deficit together with a verticalgaze palsy is pathognomonic of an impaired function of the contralateral(right) interstitial nucleus of the medial longitudinal fasciculus(RIMLF) as confirmed by MRI (figure 2) and as seen in anotherpatient.1 The RIMLF is the vertical-torsional saccade generatorlocated in the rostral midbrain.
Dual search coil recordings 2 days after the midbrain infarct. The patient was instructed to follow a laser dot that jumped from the center to 8 peripheral targets (18°). Black bars indicate when the target was visible. Vertical saccades were restricted to 10° and had an inappropriate counterclockwise component. CW = clockwise.
Disclosure: Dr. Kremmyda and N. Rettinger report no disclosures.Dr. Strupp serves as Assistant Editor of the Journal of Neurology.Dr. Buttner reports no disclosures. Dr. Glasauer holds US Patent10533767 (issued: 2006): Head-worn image recording; receivesroyalties from publishing Farben: Betrachtungen aus Philosophieund Neurowissenschaften (Suhrkamp Taschenbuch Wissenschaft,2007); served as a reviewer for the European Commission FP6;receives research support from the DFG [GL 342/1-3 (PI), FOR480 (PI), GRK 1091 (PI), Cluster of Excellence 142 (PI)], BMBF[BCCN 01GQ0440 (PI)], and the Bayerische Forschungsstiftung[and a PhD grant]; and received support from the BayerischeForschungsstiftung [Project FORBIAS (PI)].
Kremmyda O, Büttner-Ennever JA, Büttner U, Glasauer S. Torsional deviations with voluntary saccades caused by a unilateral midbrain lesion. J Neurol Neurosurg Psychiatry 2007;78:1155–1157.[Abstract/Free Full Text]
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