Skip to main content
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1992 Feb;55(2):105–111. doi: 10.1136/jnnp.55.2.105

Internuclear ophthalmoplegia of abduction: clinical and electrophysiological data on the existence of an abduction paresis of prenuclear origin.

F Thömke 1, H C Hopf 1, G Krämer 1
PMCID: PMC488970  PMID: 1538213

Abstract

Three patients showed unilateral and five bilateral abduction paresis. Five had associated adduction nystagmus of the contralateral eye. Electrophysiological testing of masseter and blink reflexes indicated an ipsilateral rostral pontine or mesencephalic lesion, and excluded a lesion of the infranuclear portion of the abducens nerve. Abduction paresis was attributed to impaired inhibition of the tonic resting activity of the antagonistic medial rectus muscle. The prenuclear origin of the disorder is based on morphological and neurophysiological evidence of an ipsilateral inhibitory connection between the paramedian pontine reticular formation and the oculomotor nucleus running close to but separated from the medial longitudinal fasciculus.

Full text

PDF
105

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bogousslavsky J., Regli F., Ostinelli B., Rabinowicz T. Paresis of lateral gaze alternating with so-called posterior internuclear ophthalmoplegia. A partial paramedian pontine reticular formation-abducens nucleus syndrome. J Neurol. 1985;232(1):38–42. doi: 10.1007/BF00314039. [DOI] [PubMed] [Google Scholar]
  2. Burde R. M., Lehman R. A., Roper-Hall G., Brooks J., Keltner J. L. Experimental internuclear ophthalmoplegia. Br J Ophthalmol. 1977 Mar;61(3):233–239. doi: 10.1136/bjo.61.3.233. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Büttner-Ennever J. A., Büttner U., Cohen B., Baumgartner G. Vertical glaze paralysis and the rostral interstitial nucleus of the medial longitudinal fasciculus. Brain. 1982 Mar;105(Pt 1):125–149. doi: 10.1093/brain/105.1.125. [DOI] [PubMed] [Google Scholar]
  4. Büttner-Ennever J. A., Henn V. An autoradiographic study of the pathways from the pontine reticular formation involved in horizontal eye movements. Brain Res. 1976 May 21;108(1):155–164. doi: 10.1016/0006-8993(76)90171-2. [DOI] [PubMed] [Google Scholar]
  5. Caplan L. R. "Top of the basilar" syndrome. Neurology. 1980 Jan;30(1):72–79. doi: 10.1212/wnl.30.1.72. [DOI] [PubMed] [Google Scholar]
  6. Cogan D. G. Internuclear ophthalmoplegia, typical and atypical. Arch Ophthalmol. 1970 Nov;84(5):583–589. doi: 10.1001/archopht.1970.00990040585005. [DOI] [PubMed] [Google Scholar]
  7. Collard M., Eber A. M., Streicher D., Rohmer F. L'ophtalmoplégie internucléaire postérieure existe-t-elle? (A propos de onze observations avec oculographie.) Rev Neurol (Paris) 1979 Apr-May;135(4):293–312. [PubMed] [Google Scholar]
  8. FINE M., MACGLASHAN C. B., Jr Unilateral internuclear ophthalmoplegia of vascular origin. AMA Arch Ophthalmol. 1956 Sep;56(3):327–337. doi: 10.1001/archopht.1956.00930040335002. [DOI] [PubMed] [Google Scholar]
  9. Goebel H. H., Komatsuzaki A., Bender M. B., Cohen B. Lesions of the pontine tegmentum and conjugate gaze paralysis. Arch Neurol. 1971 May;24(5):431–440. doi: 10.1001/archneur.1971.00480350065007. [DOI] [PubMed] [Google Scholar]
  10. Gomez C. R., Gomez S. M., Selhorst J. B. Acute thalamic esotropia. Neurology. 1988 Nov;38(11):1759–1762. doi: 10.1212/wnl.38.11.1759. [DOI] [PubMed] [Google Scholar]
  11. Gonzalez C., Reuben R. N. Ocular electromyography in the syndrome of the median longitudinal fasciculus patterns of inhibition and excitation. Am J Ophthalmol. 1967 Nov;64(5):916–926. [PubMed] [Google Scholar]
  12. Grantyn A., Grantyn R., Gaunitz U., Robiné K. P. Sources of direct excitatory and inhibitory inputs from the medial rhombencephalic tegmentum to lateral and medial rectus motoneurons in the cat. Exp Brain Res. 1980;39(1):49–61. doi: 10.1007/BF00237069. [DOI] [PubMed] [Google Scholar]
  13. Graybiel A. M. Direct and indirect preoculomotor pathways of the brainstem: an autoradiographic study of the pontine reticular formation in the cat. J Comp Neurol. 1977 Sep 1;175(1):37–78. doi: 10.1002/cne.901750105. [DOI] [PubMed] [Google Scholar]
  14. Hassler O. Arterial pattern of human brainstem. Normal appearance and deformation in expanding supratentorial conditions. Neurology. 1967 Apr;17(4):368–passim. doi: 10.1212/wnl.17.4.368. [DOI] [PubMed] [Google Scholar]
  15. Highstein S. M., Cohen B., Matsunami K. Monosynaptic projections from the pontine reticular formation to the 3rd nucleus in the cat. Brain Res. 1974 Jul 26;75(2):340–344. doi: 10.1016/0006-8993(74)90758-6. [DOI] [PubMed] [Google Scholar]
  16. Highstein S. M., Maekawa K., Steinacker A., Cohen B. Synaptic input from the pontine reticular nuclei to absucens motoneurons and internuclear neurons in the cat. Brain Res. 1976 Aug 6;112(1):162–167. doi: 10.1016/0006-8993(76)90344-9. [DOI] [PubMed] [Google Scholar]
  17. Hopf H. C., Gutmann L. Diabetic 3rd nerve palsy: evidence for a mesencephalic lesion. Neurology. 1990 Jul;40(7):1041–1045. doi: 10.1212/wnl.40.7.1041. [DOI] [PubMed] [Google Scholar]
  18. Hopf H. C., Thömke F., Gutmann L. Midbrain vs. pontine medial longitudinal fasciculus lesions: the utilization of masseter and blink reflexes. Muscle Nerve. 1991 Apr;14(4):326–330. doi: 10.1002/mus.880140406. [DOI] [PubMed] [Google Scholar]
  19. King W. M., Lisberger S. G., Fuchs A. F. Responses of fibers in medial longitudinal fasciculus (MLF) of alert monkeys during horizontal and vertical conjugate eye movements evoked by vestibular or visual stimuli. J Neurophysiol. 1976 Nov;39(6):1135–1149. doi: 10.1152/jn.1976.39.6.1135. [DOI] [PubMed] [Google Scholar]
  20. Kommerell G. Internuclear ophthalmoplegia of abduction. Isolated impairment of phasic ocular motor activity in supranuclear lesions. Arch Ophthalmol. 1975 Jul;93(7):531–534. doi: 10.1001/archopht.1975.01010020547013. [DOI] [PubMed] [Google Scholar]
  21. Kommerell G., Olivier D., Theopold H. Adaptive programming of phasic and tonic components in saccadic eye movements. Investigations of patients with abducens palsy. Invest Ophthalmol. 1976 Aug;15(8):657–660. [PubMed] [Google Scholar]
  22. Larmande A. M. La paralysie supranucléaire du VI. (dite ophtalmoplégie internucléaire postérieure) Arch Ophtalmol Rev Gen Ophtalmol. 1969 Jun-Jul;29(6):521–530. [PubMed] [Google Scholar]
  23. Loeffler J. D., Hoyt W. F., Slatt B. Motor excitation and inhibition in internuclear palsy. An electromyographic study. Arch Neurol. 1966 Dec;15(6):664–671. doi: 10.1001/archneur.1966.00470180104012. [DOI] [PubMed] [Google Scholar]
  24. Matano S. Experimental studies on the medial longitudinal fasciculus in the rabbit. V. Ascending fibers from the reticular formation and the oculomotor system. J Hirnforsch. 1970;12(4):241–253. [PubMed] [Google Scholar]
  25. Nashold B. S., Jr, Gills J. P., Jr Ocular signs from brain stimulation and lesions. Arch Ophthalmol. 1967 May;77(5):609–618. doi: 10.1001/archopht.1967.00980020611009. [DOI] [PubMed] [Google Scholar]
  26. ORLOWSKI W. J., SLOMSKI P., WOJTOWICZ S. BIELSCHOWSKY-LUTZ-COGAN SYNDROME. Am J Ophthalmol. 1965 Mar;59:416–428. doi: 10.1016/0002-9394(65)93739-6. [DOI] [PubMed] [Google Scholar]
  27. Ongerboer de Visser B. W. Afferent limb of the human jaw reflex: electrophysiologic and anatomic study. Neurology. 1982 May;32(5):563–566. doi: 10.1212/wnl.32.5.563. [DOI] [PubMed] [Google Scholar]
  28. Pierrot-Deseilligny C. H., Chain F., Gray F., Serdaru M., Escourolle R., Lhermitte F. Parinaud's syndrome: electro-oculographic and anatomical analyses of six vascular cases with deductions about vertical gaze organization in the premotor structures. Brain. 1982 Dec;105(Pt 4):667–696. doi: 10.1093/brain/105.4.667. [DOI] [PubMed] [Google Scholar]
  29. Pierrot-Deseilligny C. Circuits oculomoteurs centraux. Rev Neurol (Paris) 1985;141(5):349–370. [PubMed] [Google Scholar]
  30. Pierrot-Deseilligny C., Rigolet M. H., Chain F. Etude électromyographique de deux cas d'ophtalmoplégie internucléaire: déductions physiopathologiques. Rev Neurol (Paris) 1979 Feb;135(2):143–152. [PubMed] [Google Scholar]
  31. Pinhas I., Pinhas A., Goldhammer Y., Braham J. Progressive supranuclear palsy: electomyographic examinations of eye muscles. Acta Neurol Scand. 1978 Nov;58(5):304–308. doi: 10.1111/j.1600-0404.1978.tb02891.x. [DOI] [PubMed] [Google Scholar]
  32. Pola J., Robinson D. A. An explanation of eye movements seen in internuclear ophthalmoplegia. Arch Neurol. 1976 Jun;33(6):447–452. doi: 10.1001/archneur.1976.00500060053011. [DOI] [PubMed] [Google Scholar]
  33. Rothstein T. L., Alvord E. C., Jr Posterior internuclear ophthalmoplegia. A clinicopathological study. Arch Neurol. 1971 Mar;24(3):191–202. doi: 10.1001/archneur.1971.00480330019001. [DOI] [PubMed] [Google Scholar]
  34. Scudder C. A., Fuchs A. F., Langer T. P. Characteristics and functional identification of saccadic inhibitory burst neurons in the alert monkey. J Neurophysiol. 1988 May;59(5):1430–1454. doi: 10.1152/jn.1988.59.5.1430. [DOI] [PubMed] [Google Scholar]
  35. Steiger H. J., Büttner-Ennever J. A. Oculomotor nucleus afferents in the monkey demonstrated with horseradish peroxidase. Brain Res. 1979 Jan 5;160(1):1–15. doi: 10.1016/0006-8993(79)90596-1. [DOI] [PubMed] [Google Scholar]
  36. Topilow H. W. Posterior internuclear ophthalmoplegia of Lutz. Ann Ophthalmol. 1981 Feb;13(2):221–225. [PubMed] [Google Scholar]
  37. Vogt R. Die psychoanalytisch orientierte Kurz- and Fokaltherapie. Nervenarzt. 1975 Jan;46(1):1–10. [PubMed] [Google Scholar]
  38. Weisberg L. A. Mesencephalic hemorrhages: clinical and computed tomographic correlations. Neurology. 1986 May;36(5):713–716. doi: 10.1212/wnl.36.5.713. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES