Lopez L I, Gresty M A, Bronstein A M, du Boulay E P, Rudge P
Medical Research Council Human Movement and Balance Unit, Institute of Neurology, London, UK.
Acta Otolaryngol Suppl. 1995;520 Pt 2:285-7. doi: 10.3109/00016489509125250.
The clinical, oculomotor and ophthalmological features of 27 patients with pendular nystagmus were studied in whom 22 also had MR imaging of the brainstem. The nystagmus was predominately horizontal in 4 patients, torsional in 5, vertical in 3 and mixed in trajectory in 8. Fifteen patients had conjugate nystagmus. Twelve patients had disconjugate nystagmus. Eight patients had INO. In 16 patients visual acuity was 6/12 or worse. Acuity and the presence of INO were unrelated to the conjugacy of the nystagmus. The MRI cuts at the medullary, pontine and midbrain levels were analysed statistically to determine the areas where there was significant (< 0.05%) overlap between areas of abnormal signal in different patients. Significant target areas for lesions causing the nystagmus were: in the pons the medial vestibular nucleus, central tegmental and paramedian tracts; in the medulla the inferior olivary nucleus, reticular formation, dorsal accessory olivary nucleus, central tegmental tracts and olivo-cerebellar fibres; in the midbrain the red nucleus and central tegmental tracts. Horizontal pendular nystagmus was preferentially associated with pontine lesions and torsional nystagmus with medullary lesions. Patients with conjugate nystagmus had a tendency to have bilateral mirror image MRI lesions (p = 0.028). The prevalence of lesions in our patients raises a possibility that more than one neuronal mechanism must be affected to produce pendular nystagmus. The inferior olive may be responsible for the rhythm of ocular oscillation. The disruption of pathways proximal to the oculomotor nuclei may determine the instability in terms of individual eye movement.
对27例摆动性眼球震颤患者的临床、动眼神经及眼科特征进行了研究，其中22例还进行了脑干磁共振成像（MRI）检查。4例患者的眼球震颤以水平为主，5例为扭转性，3例为垂直性，8例轨迹混合。15例患者为共轭性眼球震颤，12例为非共轭性眼球震颤，8例有核间性眼肌麻痹（INO）。16例患者的视力为6/12或更差。视力和INO的存在与眼球震颤的共轭性无关。对延髓、脑桥和中脑水平的MRI切片进行统计学分析，以确定不同患者异常信号区域之间存在显著（<0.05%）重叠的区域。导致眼球震颤的病变的重要靶区为：脑桥中的内侧前庭核、中央被盖束和旁正中束；延髓中的下橄榄核、网状结构、背侧副橄榄核、中央被盖束和橄榄小脑纤维；中脑中的红核和中央被盖束。水平摆动性眼球震颤优先与脑桥病变相关，扭转性眼球震颤与延髓病变相关。共轭性眼球震颤患者倾向于有双侧镜像MRI病变（p = 0.028）。我们患者中病变的发生率增加了一种可能性，即必须影响不止一种神经元机制才能产生摆动性眼球震颤。下橄榄核可能负责眼球振荡的节律。动眼神经核近端通路的破坏可能决定个体眼球运动方面的不稳定性。
