Zee D S
Johns Hopkins Hospital, Baltimore, MD 21205.
Baillieres Clin Neurol. 1992 Aug;1(2):455-70.
The main findings in unilateral INO are paresis of adduction in the eye on the side of the lesion (for conjugate but not vergence eye movements) and abduction nystagmus in the eye on the side opposite to the lesion. A skew deviation (eye usually higher on the side of the lesion) or a dissociated, mixed vertical-torsional nystagmus, with the eye beating down on the side of the lesion, may also occur. The main findings in bilateral INO are paresis of adduction in both eyes, bilateral abduction nystagmus and, in the vertical plane, impaired gaze-holding, vestibular responses and smooth tracking. Abduction nystagmus in INO may have a number of causes; probably most common are a gaze-evoked nystagmus superimposed on adduction weakness and adaptation to adduction weakness. Most of the findings in INO can be explained by interruption of projections from abducens internuclear neurones, mediating adduction, and from the vestibular nuclei, mediating both canal- and otolith-induced reflexes as well as vertical gaze holding and pursuit. Extension of the lesion to structures near but outside the MLF, or involvement of cell bodies intermixed with MLF fibres, may also be important in the pathogenesis of the abduction nystagmus and the occasional slowing of abducting saccades.
单侧内侧纵束综合征的主要表现为病变侧眼球内收麻痹（用于共轭而非聚散眼球运动）以及病变对侧眼球外展眼震。也可能出现斜视角偏差（通常病变侧眼球较高）或分离性、混合性垂直扭转性眼震，病变侧眼球向下跳动。双侧内侧纵束综合征的主要表现为双眼内收麻痹、双侧外展眼震，以及在垂直平面上注视保持、前庭反应和平滑跟踪受损。内侧纵束综合征中的外展眼震可能有多种原因；可能最常见的是叠加在内收无力上的凝视诱发性眼震以及对内收无力的适应。内侧纵束综合征的大多数表现可以通过介导内收的展神经核间神经元以及介导管和耳石诱发反射以及垂直注视保持和追踪的前庭核的投射中断来解释。病变扩展至内侧纵束附近但在其外的结构，或与内侧纵束纤维混合的细胞体受累，在眼震和偶尔的外展扫视减慢的发病机制中也可能很重要。
