+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Cerebellar skew deviation and the torsional vestibuloocular reflex

Cerebellar skew deviation and the torsional vestibuloocular reflex

Neurology 65(3): 412-419

Skew deviation is typically caused by brainstem damage, and has not been identified with focal cerebellar lesions. This vertical strabismus has been attributed to asymmetric disruption of vestibuloocular reflex (VOR) projections from otolithic receptors of the utricle to ocular motoneurons, but asymmetry of the utriculo-ocular counter-roll reflex has not been detected. Lesions localized to the cerebellum were identified by MRI in five patients with vertical strabismus. Their skew deviation was measured by prism cover tests in all patients and by search coils in three patients. The angular VOR was tested in patients and 10 controls during sinusoidal +/- 10 degree torsional, vertical, and horizontal head-on-body rotations at 0.5, 1, and 2 Hz. Static torsional VOR gain was measured by the change in torsional eye position divided by change in head position during maintained head tilt. Static torsional VOR gains were asymmetric in each patient. Three patterns of asymmetry were identified: 1) decreased static gain in one eye in both directions; 2) decreased gains in both eyes in one direction; and 3) asymmetric gain in one direction in one eye alone. Dynamic torsional VOR gains were symmetrically reduced in both directions in both eyes in all patients. Focal cerebellar lesions can cause skew deviation. The static torsional vestibuloocular reflex (VOR) is linked to cerebellar control of vertical vergence. Asymmetry between the eyes or in direction of the static torsional VOR provides evidence that monocular or binocular imbalance of the utriculo-ocular reflex leads to cerebellar skew deviation.

(PDF emailed within 0-6 h: $19.90)

Accession: 011839694

Download citation: RISBibTeXText

PMID: 16087906

DOI: 10.1212/01.wnl.0000171860.02355.61

Related references

Response characteristics of the human torsional vestibuloocular reflex. Annals of the New York Academy of Sciences 656: 877-879, 1992

Recurrent attacks with skew deviation, torsional nystagmus, and contraction of the left frontalis muscle. Neurology 44(1): 177-178, 1994

The torsional vestibuloocular reflex can be canceled but not enhanced by visual stimuli. Annals of the New York Academy of Sciences 656: 886-888, 1992

Torsional eye movements in patients with skew deviation and spasmodic torticollis: responses to static and dynamic head roll. Neurology 48(2): 506-514, 1997

The effect of binocular eye position and head rotation plane on the human torsional vestibuloocular reflex. Vision Research 46(16): 2475-2486, 2006

Alternating skew deviation due to hemorrhage in the cerebellar vermis. Internal Medicine 51(19): 2793-2796, 2013

Static ocular counterroll reflex in skew deviation. Neurology 77(7): 638-644, 2011

The linear vestibulo-ocular reflex in patients with skew deviation. Investigative Ophthalmology and Visual Science 50(1): 168-174, 2008

Considerations on the mechanisms of alternating skew deviation in patients with cerebellar lesions. Journal of Vestibular Research 6(6): 395-401, 1996

Cerebellar ischemia manifesting as vertical diplopia: a case study on skew deviation. Military Medicine 180(1): E168-E173, 2016

Cerebellar role in adaptation of the goldfish vestibuloocular reflex. Journal of Neurophysiology 72(3): 1383-1394, 1994

Adaptive neural mechanism for Listing's law revealed in patients with skew deviation caused by brainstem or cerebellar lesion. Investigative Ophthalmology & Visual Science 49(1): 204-214, 2008

Effect of cerebellar inactivation by lidocaine microdialysis on the vestibuloocular reflex in goldfish. Journal of Neurophysiology 79(3): 1286-1294, 1998

Cerebellar disease alters the axis of the high-acceleration vestibuloocular reflex. Journal of Neurophysiology 94(5): 3417-3429, 2005

A model of cerebellar-brainstem interaction in the adaptive control of the vestibuloocular reflex. Acta Oto-Laryngologica. Supplementum 481: 428-432, 1991