title: Patterns of dissociate torsional-vertical nystagmus in internuclear ophthalmoplegia.
abstract: To explore the patterns and mechanisms of jerky seesaw nystagmus in internuclear ophthalmoplegia (INO), we analyzed the nystagmus patterns in 33 patients with dissociated torsional-vertical nystagmus and INO. In 11 (33%) patients, the nystagmus was ipsiversive torsional in both eyes with vertical components in the opposite directions. In contrast, 18 (55%) patients showed ipsiversive torsional nystagmus with a larger upbeat component in the contralesional eye. Four (12%) patients exhibited ipsiversive torsional nystagmus with a greater downbeat component in the ipsilesional eye. At least one component of contraversive ocular tilt reaction was associated in most patients (30/33, 91%). The patterns of jerky seesaw nystagmus in INO suggest a disruption of neural pathways from the contralateral vertical semicircular canals with or without concomitant damage to the fibers from the contralateral utricle in or near the medial longitudinal fasciculus.
authors.affiliation: Departments of Neurology, Seoul National University Bundang Hospital, Seoul, Korea.
authors.forename: Seong-Hae
authors.initials: SH
authors.lastname: Jeong
authors.forename: Eung Kyu
authors.initials: EK
authors.lastname: Kim
authors.forename: Jun
authors.initials: J
authors.lastname: Lee
authors.forename: Kwang-Dong
authors.initials: KD
authors.lastname: Choi
authors.forename: Ji Soo
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053483:Eye Movement Measurements; D005133:Eye Movements / Q000502:physiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009759:Nystagmus, Pathologic / Q000150:complications* / Q000503:physiopathology*; D015835:Ocular Motility Disorders / Q000150:complications* / Q000503:physiopathology*; D012444:Saccule and Utricle / Q000294:innervation / Q000503:physiopathology; D012665:Semicircular Canals / Q000294:innervation / Q000503:physiopathology; D014795:Visual Pathways / Q000503:physiopathology