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Published 2 February 2009
Cite this as: BMJ Case Reports 2009 [doi:10.1136/bcr.08.2008.0807]
Copyright © 2009 by the BMJ Publishing Group Ltd.

Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Torsional deviations with voluntary saccades caused by a unilateral midbrain lesion

Olympia Kremmyda1, Jean A Büttner-Ennever2, Ulrich Büttner1, Stefan Glasauer3

1 Ludwig Maximilians University, Neurology, Marchioninistr. 23, Munich, 81377, Germany
2 Ludwig Maximilians University, Anatomy, Marchioninistr. 23, Munich, 81377, Germany
3 Ludwig Maximilians University, Marchioninistr 23, Munich, 81377, Germany

Correspondence to:
S.Glasauer{at}lrz.uni-muenchen.de

SUMMARY

Three dimensional eye rotations were measured using the magnetic search coil technique in a patient with a lesion of the right rostral interstitial nucleus of the medial longitudinal fasciculus (RIMLF) and in four control subjects. Up to 10° contralesional torsional deviations with each voluntary saccade were revealed, which also could be seen during bedside examination. There was no spontaneous nystagmus. Based on MRI criteria, the lesion involved the RIMLF but spared the interstitial nucleus of Cajal. To date, this deficit has not been described in patients. Our results support the hypothesis that the vertical-torsional saccade generator in humans is organised similarly as in monkeys: each RIMLF encodes torsional saccades in one direction, while both participate in vertical saccades.


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