Multiple Sclerosis

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906-4
Multiple Sclerosis
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Eye Movements

• Transient spontaneous primary position upbeat
  nystagmus with lid nystagmus
• Rapid bursts of horizontal square wave
  oscillations opening her eyes to fix on a target.
• Horizontal gaze evoked rotary (torsional)
  nystagmus
• (Rotation of the globe is best seen by
  observing conjunctival blood vessels).

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Eye Movements

• Gaze evoked unsustained upbeat nystagmus
• Saccadic pursuit except on downgaze
• Saccadic Dysmetria
• Hypermetria left gaze to center.

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Clinical Features of Upbeat Nystagmus
Leigh JR and Zee DS. The Neurology of Eye
Movements 4th Edition. Oxford University Press,
New York 2006 with permission
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Upbeat Nystagmus
Localizes to the Caudal Medulla with lesion
affecting the Perihypoglossal group of nuclei
including nucleus
intercalatus nucleus of
Roller nucleus of pararaphales
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Upbeat Nystagmus
More rostral brainstem lesions may interrupt the
ventral tegmental tract containing projections
from the vestibular nuclei that receive inputs
from the anterior semicircular canal or Involve
the brachuim conjunctivum in the rostral pons and
Medulla.
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Etiology of Upbeat Nystagmus
Leigh JR and Zee DS. The Neurology of Eye
Movements 4th Edition. Oxford University Press,
New York 2006 with permission
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Clinical Features of Torsional Nystagmus
Leigh JR and Zee DS. The Neurology of Eye
Movements 4th Edition. Oxford University Press,
New York 2006 with permission
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Neuroimaging
Figure 1 Series of sagittal and axial FLAIR scans
show classical calloseptal and deep
periventricular foci of increased signal
intensity surrounding cavatating areas in this
patient with long standing MS
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Neuroimaging
Note a small foci in the pons
Note perpendicular orientation Towards the
ventricle classic forDawson fingers
Courtesy of Anne Osborn,M.D.
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References
Leigh RJ, Zee DS. Diagnosis of Nystagmus and
Saccadic Intrusion. Chp 10475-558. In The
Neurology of Eye Movements, 4th Edition, Oxford
University Press, New York, 2006. Tilikete C,
Koene A, Nighoghossian N., Vighetto A, Pélisson .
Saccadic lateropulsion in Wallenberg syndrome a
window to access cerebellar control of saccades?
Exp Brain Res 2006 174(3)555-65.
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References
Tilikete C. Hermier M. Pelisson D, Vighetto A.
Saccadic lateropulsion and primary position
upbeat nystagmus disorders of caudal medulla.
Ann Neurol 2002 52658-662.
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