Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
    • Education
  • Online Sections
    • Neurology Video Journal Club
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
    • Education
  • Online Sections
    • Neurology Video Journal Club
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

Share

November 02, 2021; 97 (18) Resident & Fellow Section

Teaching Video NeuroImage: Bilateral Horizontal Gaze Palsies With Vertical Ocular Dysmetria From a Demyelinating Lesion of the Pontine Tegmentum

Anthony Fok, Jason J.S. Barton
First published June 7, 2021, DOI: https://doi.org/10.1212/WNL.0000000000012328
Anthony Fok
From the Department of Neuroscience (A.F.), Monash Health; Department of Neurology (A.F.), Royal Melbourne Hospital, Australia; and Departments of Medicine (Neurology), Ophthalmology and Visual Sciences, and Psychology (J.J.S.B.), University of British Columbia, Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jason J.S. Barton
From the Department of Neuroscience (A.F.), Monash Health; Department of Neurology (A.F.), Royal Melbourne Hospital, Australia; and Departments of Medicine (Neurology), Ophthalmology and Visual Sciences, and Psychology (J.J.S.B.), University of British Columbia, Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Full PDF
Citation
Teaching Video NeuroImage: Bilateral Horizontal Gaze Palsies With Vertical Ocular Dysmetria From a Demyelinating Lesion of the Pontine Tegmentum
Anthony Fok, Jason J.S. Barton
Neurology Nov 2021, 97 (18) e1868-e1869; DOI: 10.1212/WNL.0000000000012328

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Permissions

Make Comment

See Comments

Downloads
360

Share

  • Article
  • Figures & Data
  • Info & Disclosures
Loading

Impaired bilateral conjugate horizontal saccades can occur from bilateral abducens nuclear lesions,1 as seen in our patient with multiple sclerosis (Video 1 and Figure). Each abducens nucleus is a horizontal gaze center and innervates the ipsilateral lateral rectus through the abducens fascicle and the contralateral medial rectus via the medial longitudinal fasciculus (Figure). Thus, bilateral lesions of the abducens nuclei cause complete horizontal gaze paresis.

Video 1

Complete horizontal gaze palsy with vertical ocular dysmetria. The patient displays impaired bilateral horizontal saccades and pursuits. Vergence is controlled by the midbrain and is preserved. The horizontal vestibular ocular reflex is deficient, confirming the nuclear location of the lesion. There is vertical ocular dysmetria centripetally, with slow oscillating eye movements until reaching target, meaning that cerebellar connections are involved.Download Supplementary Video 1 via http://dx.doi.org/10.1212/012328_Video_1

Figure
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure Localization of the Lesion Responsible for Complete Horizontal Gaze Palsy

(A) Axial and sagittal MRI brain shows T2-weighted hyperintensity in dorsal pons extending to right middle cerebellar peduncle. (B) Anatomic relationships between the abducens nuclei (VI), middle cerebellar peduncles, oculomotor nuclei (III), and vergence center. Pathways for right conjugate gaze are in green; for left conjugate gaze, in blue. Bilateral VI lesions (shaded area) cause loss of horizonal saccadic, pursuit, and reflex vestibular movements. By contrast, a more ventral lesion of the paramedian pontine reticular formation (PPRF) would impair horizontal saccadic generation without affecting pursuit or vestibular ocular reflex. A more rostral lesion causes internuclear ophthalmoplegia by interrupting the medial longitudinal fasciculus (MLF). The figure was created with Biorender.com. LR = lateral rectus; MR = medial rectus; MVN = medial vestibular nucleus.

The patient also exhibits ocular dysmetria. Cogan2 described ocular dysmetria from lesions of the cerebellum or its immediate connections. This presents with overshoot (less commonly undershoot) movements of the eyes, with fast, small-amplitude corrective saccades of diminishing size until reaching the visual target. The involvement of the middle cerebellar peduncle is the likely cause for this sign in our patient.

Study Funding

No targeted funding reported.

Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

Acknowledgment

The authors thank A/Prof. Kempster (Monash University) for editing assistance.

Footnotes

  • Go to Neurology.org/N for full disclosures.

  • Teaching Slides links.lww.com/WNL/B449

  • © 2021 American Academy of Neurology

References

  1. 1.↵
    1. Leigh RJ,
    2. Zee DS
    . The Neurology of Eye Movements, 5th ed. Oxford University Press; 2015.
  2. 2.↵
    1. Cogan DG
    . Ocular dysmetria; flutter-like oscillations of the eyes and opsoclonus. AMA Arch Ophthalmol. 1954;51:218-335.
    OpenUrl

Disputes & Debates: Rapid online correspondence

No comments have been published for this article.
Comment

REQUIREMENTS

If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org

Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.

If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.

Submission specifications:

  • Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
  • Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
  • Submit only on articles published within 6 months of issue date.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose Comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All authors, besides the first/corresponding author, must complete a separate Publishing Agreement Form and provide via email to the editorial office before comments can be posted.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

You May Also be Interested in

Back to top
  • Article
    • Study Funding
    • Disclosure
    • Acknowledgment
    • Footnotes
    • References
  • Figures & Data
  • Info & Disclosures
Advertisement

Related Articles

  • Resident & Fellow Rounds: November 2021

Topics Discussed

  • Ocular motility
  • Multiple sclerosis
  • Oscillopsia

Alert Me

  • Alert me when eletters are published
Neurology: 99 (7)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • Neurology: Education
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2022 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise