Bogousslavsky J, Regli F, Ostinelli B, Rabinowicz T
J Neurol. 1985;232(1):38-42. doi: 10.1007/BF00314039.
A patient with multiple myeloma developed gaze paresis to the left with slowed saccades and gaze-paretic nystagmus, which alternated with abduction palsy in the left eye (with preserved oculocephalic deviation) and dissociated adducting nystagmus in the right eye, suggesting so-called posterior internuclear ophthalmoplegia. At autopsy multiple small infarcts were found with partial destruction of the left paramedian pontine reticula formation (PPRF) extending towards the abducens nucleus, which was involved only in its inferior pole. The medial longitudinal fasciculus and other oculomotor structures were spared. It is suggested that slowing of all ipsilateral saccades with gaze-paretic nystagmus corresponded to partial destruction of the PPRF, and that intermitted abduction palsy in the ipsilateral eye with adduction nystagmus in the fellow eye was due to intermittant dysfunction of the abducens nucleus. Involvement of voluntary saccades, pursuit movements and vestibulo-ocular responses may be dissociated in partial lesions of the abducens nucleus.
一名多发性骨髓瘤患者出现向左凝视麻痹，眼球扫视减慢，伴有凝视性眼球震颤，与左眼外展麻痹交替出现（眼前庭反射保留），右眼出现分离性内收眼球震颤，提示所谓的后核间性眼肌麻痹。尸检发现多个小梗死灶，左侧脑桥旁正中网状结构（PPRF）部分破坏并延伸至展神经核，仅展神经核下极受累。内侧纵束和其他动眼神经结构未受影响。提示所有同侧眼球扫视减慢伴有凝视性眼球震颤与PPRF部分破坏相对应，同侧眼间歇性外展麻痹伴对侧眼内收眼球震颤是由于展神经核间歇性功能障碍所致。展神经核部分病变时，随意眼球扫视、跟踪运动和前庭眼反射的受累情况可能会出现分离。
