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Update on the medial longitudinal fasciculus syndrome

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Abstract

The medial longitudinal fasciculus is a key structure for conjugate horizontal eye movements by relaying signals from the abducens internuclear neurons to the medial rectus subdivision of the contralateral oculomotor nucleus. Thus, lesions involving the medial longitudinal fasciculus give rise to a typical neuro-ophthalmological sign, the internuclear ophthalmoplegia, which is characterized by impaired adduction of the ipsilesional eye and dissociated abducting nystagmus of the contralateral eye during attempted contralesional horizontal gaze. In addition, medial longitudinal fasciculus lesions may produce various other ocular motor abnormalities since the medial longitudinal fasciculus also conveys the signals for the control of the vestibulo-ocular reflex and smooth pursuit. Other possible ocular motor abnormalities include spontaneous vertical-torsional nystagmus, contraversive ocular tilt reaction, and impaired vestibulo-ocular reflex, especially for the contralesional posterior canal. Recognition of the ocular motor findings observed in the medial longitudinal fasciculus syndrome would aid in detection and localization of potentially grave lesions involving the brainstem.

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Authors and Affiliations

  1. Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea

    Seung-Han Lee & Jae-Myung Kim

  2. Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, South Korea

    Ji-Soo Kim

Authors
  1. Seung-Han Lee
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  2. Jae-Myung Kim
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Contributions

SH Lee conceived the study, analyzed the data, reviewed the literatures, and drafted the manuscript and approved the final version of the manuscript.

JM Kim analyzed the data, reviewed the literatures, and approved the final version of the manuscript.

JS Kim analyzed the data, critically reviewed the manuscript, and approved the final version of the manuscript.

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Correspondence to Seung-Han Lee.

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The authors declare that they acted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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The authors declare no competing interests.

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Informed consent was obtained from all individual participants included in the study.

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Supplementary Information

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Supplementary file1 (MP4 86594 KB) This video clip illustrates typical ophthalmoplegia (impaired adduction of the ipsilesional eye), dissociated abducting nystagmus in the contralesional eye and spared convergence. This patient has a pontine tegmental infarction involving the right medial longitudinal fasciculus. This patient also has spontaneous vertical-torsional nystagmus during the acute phase. Bedside head impulse testing reveals abnormal catch-up saccades during stimulation of the left posterior canal. Diffusion MRI and video head impulse testing of this patient are shown in the figure 2-A.

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Lee, SH., Kim, JM. & Kim, JS. Update on the medial longitudinal fasciculus syndrome. Neurol Sci 43, 3533–3540 (2022). https://doi.org/10.1007/s10072-022-05967-3

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  • DOI: https://doi.org/10.1007/s10072-022-05967-3

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