Journal of Neurology ( IF 4.8 ) Pub Date : 2024-02-14 , DOI: 10.1007/s00415-023-12155-6 Maximilian U Friedrich 1, 2 , Laurin Schappe 3 , Sashank Prasad 4 , Helen Friedrich 1 , Michael D Fox 1, 2 , Andreas Zwergal 5, 6 , David S Zee 7 , Klaus Faßbender 4 , Klaus-Ulrich Dillmann 4
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Background
Disconjugate eye movements are essential for depth perception in frontal-eyed species, but their underlying neural substrates are largely unknown. Lesions in the midbrain can cause disconjugate eye movements. While vertically disconjugate eye movements have been linked to defective visuo-vestibular integration, the pathophysiology and neuroanatomy of horizontally disconjugate eye movements remains elusive.
Methods
A patient with a solitary focal midbrain lesion was examined using detailed clinical ocular motor assessments, binocular videooculography and diffusion-weighted MRI, which was co-registered to a high-resolution cytoarchitectonic MR-atlas.
Results
The patient exhibited both vertically and horizontally disconjugate eye alignment and nystagmus. Binocular videooculography showed a strong correlation of vertical and horizontal oscillations during fixation but not in darkness. Oscillation intensities and waveforms were modulated by fixation, illumination, and gaze position, suggesting shared visual- and vestibular-related mechanisms. The lesion was mapped to a functionally ill-defined area of the dorsal midbrain, adjacent to the posterior commissure and sparing nuclei with known roles in vertical gaze control.
Conclusion
A circumscribed region in the dorsal midbrain appears to be a key node for disconjugate eye movements in both vertical and horizontal planes. Lesioning this area produces a unique ocular motor syndrome mirroring hallmarks of developmental strabismus and nystagmus. Further circuit-level studies could offer pivotal insights into shared pathomechanisms of acquired and developmental disorders affecting eye alignment.
中文翻译：
中脑损伤引起的分离凝视：眼部排列的统一回路机制？
背景
解共轭眼球运动对于额眼物种的深度感知至关重要，但其潜在的神经基质在很大程度上是未知的。中脑损伤可导致眼球运动失调。虽然垂直不共轭眼球运动与视觉前庭整合缺陷有关，但水平不共轭眼球运动的病理生理学和神经解剖学仍然难以捉摸。
方法
使用详细的临床眼运动评估、双眼视频眼科检查和扩散加权 MRI 对一名患有孤立性局灶性中脑病变的患者进行了检查，并将其共同注册到高分辨率细胞结构 MR 图谱上。
结果
患者表现出垂直和水平方向的眼球排列失调和眼球震颤。双眼视频眼科检查显示，在注视期间垂直和水平振荡具有很强的相关性，但在黑暗中则不然。振荡强度和波形受注视、照明和注视位置的调节，表明共同的视觉和前庭相关机制。病变被定位到背侧中脑功能不明确的区域，邻近后连合和在垂直凝视控制中具有已知作用的备用核。
结论
背侧中脑的一个限制区域似乎是在垂直和水平面上分离眼球运动的关键节点。损害该区域会产生独特的眼运动综合征，反映发育性斜视和眼球震颤的特征。进一步的回路水平研究可以为影响眼睛排列的获得性和发育性疾病的共同病理机制提供关键的见解。
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