Abstract
In this chapter the characteristics of spontaneous and evoked eye movements in severely ill patients are described. Eye movements provide valuable information on lesion location and on the grade and prognosis of coma. While voluntary eye movements such as saccades, smooth pursuit, vergence, and optokinetic nystagmus (OKN) can be examined in the cooperative patient, spontaneous eye position and movement and the vestibulo-ocular reflex (VOR) can be evaluated only in patients with stupor and coma. The following sections provide a guideline for the differentiation and assessment of various eye movement disorders in both alert and comatose patients.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Suggested Reading
Barnes GR, Forbat LN (1979) Cervical and vestibular afferent control of ocular motor response in man. Acta Otolaryngol (Stockh) 88: 79–87
Brandt T (1991) Vertigo. Its multisensory syndromes. Springer, London
Brandt T, Dieterich M (1993) Skew deviation with ocular torsion, a vestibular brainstem sign of topological diagnostic value. Ann Neurol 33: 528–534
Bronstein AM, Hood JD (1986) The cervicoocular reflex in normal subjects and patients with absent vestibular function. Brain Res 373: 399–408
Brusa A, Firpo MP, Massa S, Piccardo A, Bronzini E (1984) Typical and reverse bobbing: a case with localizing value. Eur Neurol 23: 151–155
Buettner UW, Zee DS (1989) Vestibular testing in comatose patients. Arch Neurol 46: 561–563
Cannon SC, Zee DS (1988) The neural integrator of the oculomotor system. In: Lessel S, van Dalen JTW (eds) Current neuroophthalmology. Mosby, St. Louis, pp 123–138
Daroff RB, Waldmann AL (1965) Ocular bobbing. J Neurol Neurosurg Psychiatry 28: 375–377
Drake ME Jr, Erwin CW, Massey EW (1982) Ocular bobbing in metabolic encephalopathy: clinical, pathologic, and electrophysiologic study. Neurology 32: 1029–1031
Fisher CM (1964) Ocular bobbing. Arch Neurol 11: 543–546
Fisher CM (1969) The neurological examination of the comatose patient. Acta Neurol Scand 45 [Suppl 36]: 1–56
Hata S, Bernstein E, Davis LE (1986) Atypical ocular bobbing in acute organophosphate poisoning. Arch Neurol 43: 185–186
Henn V, Baloh RW, Hepp K (1984) The sleep-wake transition in the oculomotor system. Exp Brain Res 54: 166–176
Katz B, Hoyt WF, Townsend J (1982) Ocular bobbing and unilateral pontine hemorrhage. J Clin Neuro Ophthalmol 2: 193–195
Keane JR (1985) Pretectal pseudobobbing. Five patients with “V”-pattern convergence nystagmus. Arch Neurol 42: 592–594
Keane JK (1986) Acute vertical myoclonus. Neurology 36: 86–89
Larmande P, Dongmo L, Limodin J, Ruchoux M (1987) Periodic alternating gaze: a case without any hemispheric lesion. Neurosurgery 20: 481–483
Leigh RJ, Zee DS (1991) The neurology of eye movements, 2nd edn. Davis, Philadelphia
Mueller-Jensen A, Neunzig H-P, Emskoetter T (1987) Outcome prediction in comatose patients: significance of reflex eye movement analysis. J Neurol Neurosurg Psychiatry 50: 389–392
Nakada T, Kwee IL, Lee H (1984) Sustained upgaze in coma. J Clinical Neuro Ophthalmol 4: 35–37
Noda S, Ide K, Umezaki H, Itoh H, Yamamota K (1987) Repetitive divergence. Ann Neurol 21: 109–110
Plum F, Posner JB (1980) The diagnosis of stupor and coma, 3rd edn. Davis, Philadelphia
Ropper AH (1981) Ocular dipping in anoxic coma. Arch Neurol 38: 297–299
Rosenberg ML, Calvert PC (1986) Ocular bobbing in association with other signs of midbrain dysfunction. Arch Neurol 43: 314
Senelick R (1976) “Ping-pong” gaze. Periodic alternating gaze deviation. Neurology 26: 532–535
Simon RP (1978) Forced downward ocular deviation. Occurrence during oculovestibular testing in sedative drug-induced coma. Arch Neurol 35: 456–458
Stewart JD, Kirkham TH, Mathieson G (1979) Periodic alternating gaze. Neurology 29: 222–224
Susac JO, Hoyt WF, Daroff RB, Lawrence W (1970) Clinical spectrum of ocular bobbing. J Neurol Neurosurg Psychiatry 33: 771–775
Tusa RJ, Zee DS, Herdman SJ (1986) Effect of unilateral cerebral cortical lesions on ocular motor behavior in monkeys: saccades and quick phases. J Neurophysiol 56: 1590–1625
Tusa RJ, Ungerleider LG (1988) Fiber pathways of cortical areas mediating smooth pursuit eye movements in monkeys. Ann Neurol 23: 174–183
Tusa RJ, Kaplan PW, Hain TC, Naidu S (1990) Ipsiversive eye deviation and epileptic nystagmus. Neurology 40: 662–665
Tusa RJ (1989) Saccadic eye movements. Supranuclear control. Bull Soc Belge Ophthalmol 237: 67–111
Walsh FB, Hoyt WF (1988) Clinical neuro-ophthalmology, 4th edn. Williams and Wilkins, Baltimore
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1994 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Dieterich, M., Tusa, R.J., Hanley, D.F. (1994). Ocular Motor Disturbances. In: Hacke, W., Hanley, D.F., Einhäupl, K.M., Bleck, T.P., Diringer, M.N., Ropper, A.H. (eds) Neurocritical Care. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-87602-8_31
Download citation
DOI: https://doi.org/10.1007/978-3-642-87602-8_31
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-87604-2
Online ISBN: 978-3-642-87602-8
eBook Packages: Springer Book Archive