Kim Hyun Sung, Choi Jae-Hwan, Oh Eun Hye, Choi Seo Young, Choi Kwang-Dong
Department of Neurology, Gyeongsang National University Changwon Hospital, Changwon, South Korea.
Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
Eur J Neurol. 2025 Jan;32(1):e70010. doi: 10.1111/ene.70010.
The dorsolateral portion of the caudal pons contains the vestibular nucleus (VN) and inferior cerebellar peduncle (ICP) that play important roles in conveying and processing vestibular and ocular motor signals. This study aimed to characterize ocular motor abnormalities along with their anatomical correlations in dorsolateral pons (DLP) lesions.
We analyzed clinical features, and results of neuro-otological evaluations and neuroimaging of 18 patients with unilateral DLP lesions (17 with DLP infarction and 1 with cavernous malformation) from among 506 patients with pontine infarction in a stroke registry.
Most of the patients (n = 16) presented with isolated acute vestibular syndrome (AVS). The involved structures within the DLP were the ICP in four patients and the VN in the remaining 14. The unilateral ICP lesions were associated with consistent abnormalities in vestibular and ocular motor tests, including ipsilesional nystagmus without gaze-evoked nystagmus (GEN), and normal head impulse tests (HITs) and caloric response. In contrast, lesions of the VN were associated with a broader range of eye-movement abnormalities, including ipsi- or contralesional nystagmus with GEN, positive HITs, normal or abnormal caloric responses, and fixation nystagmus. Initial diffusion-weighted magnetic resonance imaging (within 48 h) was falsely negative in 41% (n = 7) of the DLP infarction cases.
This study demonstrates that unilateral DLP lesions frequently present with isolated AVS and diverse ocular motor abnormalities. These characteristics may be due to the complex involvement of afferent or efferent fibers to and from the VN.
脑桥尾部的背外侧部分包含前庭核（VN）和小脑下脚（ICP），它们在传递和处理前庭及眼球运动信号方面发挥着重要作用。本研究旨在明确脑桥背外侧（DLP）病变时的眼球运动异常及其解剖学关联。
我们从一个卒中登记库中的506例脑桥梗死患者中，分析了18例单侧DLP病变患者（17例为DLP梗死，1例为海绵状畸形）的临床特征、神经耳科学评估结果及神经影像学表现。
大多数患者（n = 16）表现为孤立性急性前庭综合征（AVS）。DLP内受累结构在4例患者中为ICP，其余14例为VN。单侧ICP病变与前庭和眼球运动测试中的一致性异常相关，包括患侧眼球震颤而无凝视诱发眼球震颤（GEN），以及正常的头脉冲试验（HITs）和冷热试验反应。相比之下，VN病变与更广泛的眼球运动异常相关，包括患侧或对侧眼球震颤伴GEN、阳性HITs、正常或异常的冷热试验反应以及注视性眼球震颤。在41%（n = 7）的DLP梗死病例中，初始扩散加权磁共振成像（48小时内）呈假阴性。
本研究表明，单侧DLP病变常表现为孤立性AVS和多样的眼球运动异常。这些特征可能归因于进出VN的传入或传出纤维的复杂受累。
