Dorsolateral pontine lesions produce distinct ocular motor abnormalities with anatomical correlations

IF 4.5 2区医学 Q1 CLINICAL NEUROLOGY

European Journal of Neurology Pub Date : 2024-12-21 DOI:10.1111/ene.70010

Hyun Sung Kim, Jae-Hwan Choi, Eun Hye Oh, Seo Young Choi, Kwang-Dong Choi

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Abstract

Background and Purpose

The dorsolateral portion of the caudal pons contains the vestibular nucleus (VN) and inferior cerebellar peduncle (ICP) that play important roles in conveying and processing vestibular and ocular motor signals. This study aimed to characterize ocular motor abnormalities along with their anatomical correlations in dorsolateral pons (DLP) lesions.

Methods

We analyzed clinical features, and results of neuro-otological evaluations and neuroimaging of 18 patients with unilateral DLP lesions (17 with DLP infarction and 1 with cavernous malformation) from among 506 patients with pontine infarction in a stroke registry.

Results

Most of the patients (n = 16) presented with isolated acute vestibular syndrome (AVS). The involved structures within the DLP were the ICP in four patients and the VN in the remaining 14. The unilateral ICP lesions were associated with consistent abnormalities in vestibular and ocular motor tests, including ipsilesional nystagmus without gaze-evoked nystagmus (GEN), and normal head impulse tests (HITs) and caloric response. In contrast, lesions of the VN were associated with a broader range of eye-movement abnormalities, including ipsi- or contralesional nystagmus with GEN, positive HITs, normal or abnormal caloric responses, and fixation nystagmus. Initial diffusion-weighted magnetic resonance imaging (within 48 h) was falsely negative in 41% (n = 7) of the DLP infarction cases.

Conclusions

This study demonstrates that unilateral DLP lesions frequently present with isolated AVS and diverse ocular motor abnormalities. These characteristics may be due to the complex involvement of afferent or efferent fibers to and from the VN.

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脑桥背外侧病变会产生与解剖学相关的明显眼球运动异常

背景和目的尾部脑桥背外侧部分包含前庭核（VN）和小脑下丘（ICP），它们在传达和处理前庭和眼球运动信号方面发挥着重要作用。本研究旨在描述背外侧脑桥（DLP）病变患者眼球运动异常的特征及其解剖学相关性。方法我们分析了脑卒中登记处 506 例脑桥梗死患者中 18 例单侧 DLP 病变患者（17 例 DLP 梗死，1 例海绵畸形）的临床特征、神经肌肉学评估和神经影像学结果。结果大多数患者（16 人）表现为孤立的急性前庭综合征（AVS）。在 DLP 中，4 名患者的受累结构为 ICP，其余 14 名患者的受累结构为 VN。单侧 ICP 病变与前庭和眼球运动测试的一致异常有关，包括无凝视诱发眼球震颤（GEN）的同侧眼球震颤，以及正常的头部冲动测试（HIT）和热量反应。相比之下，VN 的病变与更广泛的眼球运动异常有关，包括伴有 GEN 的同侧或对侧性眼球震颤、阳性 HIT、正常或异常的热量反应以及固定性眼球震颤。在 41% 的 DLP 梗死病例（7 例）中，最初的弥散加权磁共振成像（48 小时内）呈假阴性。结论本研究表明，单侧 DLP 病变常伴有孤立的 AVS 和多种眼球运动异常。这些特征可能是由于进出 VN 的传入或传出纤维复杂受累所致。

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来源期刊

European Journal of Neurology 医学-临床神经学

CiteScore

9.70

自引率

2.00%

发文量

418

审稿时长

1 months

期刊介绍： The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).