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Pendular Oscillation and Ocular Bobbing After Pontine Hemorrhage

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Abstract

The pathophysiology of acute, vertical spontaneous eye movements following pontine hemorrhage is not well understood. Here, we present and discuss the video-oculography findings of a patient with acute pontine hemorrhage who developed vertical pendular oscillation and ocular bobbing while comatose. The amplitudes, peak velocities, frequency distribution, and phase planes (velocity versus position) of the eye movements were analyzed. The vertical pendular oscillation was rhythmic with a peak frequency of 1.7 Hz, but amplitudes (mean 1.9°, range 0.2–8.2°) and peak velocities (mean 20.6°/s; range 5.9–60.6°/sec) fluctuated. Overall, their peak velocities were asymmetric, faster with downward than upward. Higher peak velocities were seen with larger amplitudes (downward phase r = 0.95, p < 0.001; upward phase r = 0.91, p < 0.001) and with movements beginning at eye positions lower in the orbit (downward phase r = − 0.64, p < 0.001; upward phase r = − 0.86, p < 0.001). Interspersed were typical ocular bobbing waveforms with a fast (peak velocity 128.8°/s), large-amplitude (17.5°) downward movement, sometimes followed by a flat interphase interval (0.5 s) when the eye was nearly stationary, and then a slow return to mid-position with a decaying velocity waveform. To account for the presence and co-existence of pendular oscillations and bobbing, we present and discuss three hypothetical models, not necessarily mutually exclusive: (1) oscillations originating in the inferior olives due to disruption of the central tegmental tract(s); (2) unstable neural integrator function due to pontine cell group damage involving neurons involved in gaze-holding; (3) low-frequency saccadic intrusions following omnipause neuron damage.

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Acknowledgements

We thank Dr. Aasef Shaikh for sharing the raw data of oculopalatal tremor in his previous research to us for comparison.

Data Availability Statement

All available data can be obtained by contacting the corresponding author.

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Authors and Affiliations

  1. Department of Neurology, Neuro-medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec.1, Fengxing Rd., Tanzi Dist., Taichung City, 42743, Taiwan

    Tzu-Pu Chang

  2. Department of Neurology, School of Medicine, Tzu Chi University, Hualien, Taiwan

    Tzu-Pu Chang

  3. Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe St Pathology 2-210, Baltimore, MD, 21287, USA

    Daniel R. Gold, Jorge Otero-Millan & David S. Zee

  4. Department of Neurosurgery, Neuro-medical Scientific Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan

    Bor-Ren Huang

  5. Department of Neurosurgery, School of Medicine, Tzu Chi University, No. 88, Sec.1, Fengxing Rd., Tanzi Dist, Taichung City, 42743, Taiwan

    Bor-Ren Huang

Authors
  1. Tzu-Pu Chang
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  2. Daniel R. Gold
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  3. Jorge Otero-Millan
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  4. Bor-Ren Huang
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  5. David S. Zee
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Contributions

Tzu-Pu Chang collected the data, interpreted the data, drafted the manuscript and revised the manuscript.

Daniel R. Gold interpreted the data, drafted the manuscript and revised the manuscript.

Jorge Otero-Millan analyzed and interpreted the data.

Bor-Ren Huang collected the data.

David S. Zee interpreted the data, drafted the manuscript and revised the manuscript.

Corresponding author

Correspondence to David S. Zee.

Ethics declarations

The study was performed in accordance with the ethical standards laid down in the Declaration of Helsinki (1964).

Informed Consent

The informed and written consent for publication of the data and videos was obtained by the patient’s family.

Conflict of Interests

The authors declare that they have no conflict of interest.

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Chang, TP., Gold, D.R., Otero-Millan, J. et al. Pendular Oscillation and Ocular Bobbing After Pontine Hemorrhage. Cerebellum 20, 734–743 (2021). https://doi.org/10.1007/s12311-019-01086-6

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