Tajima M
No Shinkei Geka. 1976 May;4(5):459-64.
The examinations of gaze and optokinetic nystagmus were porformed at bed side before and after craniotomy. Gaze nystagmus were observed regularly in 120 cases who got the intracranial surgical procedures in Nagoya university hospital. Postoperative nystagmus which were not seen before operation appeared in 16 cases of 91 patients with supratentorial lesions and 24 cases of 27 patients with infratentorial lesions. These postoperative nystagmus continued for from 3 days to 21 days. The state of the direction of spontaneous horizontal nystagmus and directional preponderance were examined on 23 cases who were diagnosed as having unilateral lesion. In the cases with supratentorial lesion, the nystagmus appeared to be dominant toward the affected side, while in patients with infratentorial lesion, it had a tendency to be dominant toward the intact side. The mechanism of spontaneous and gaze nystagmus was discussed. The investigation could not conform whether nystagmus in supratentorial lesion was caused due to disturbance of the cerebral cortex or secondary disturbance of the brain stem. The postoperative nystagmus in the infratentorial lesion was possibly caused by the potoperative edema, operative injury, circulatory disturbance, and anoxia. Examinations of the optokinetic nystagmus had been done with hand-made drum at bed side for several weeks until the patients were stabilized. In most of 52 cases, horizontal optokinetic nystagmus were decreased in their frequency after craniotomy and gradually increased again. The similar observations were done in both supra- and infratentorial lesions. The optokinetic directional preponderance was examined on 30 cases diagnosed as having unilateral lesion. Eight supratentorial cases showed the decrease of intact side nystagmus and 2 infratentorial cases showed the decrease of affected side. The change of postoperative transient gaze nystagmus and horizontal optokinetic nystagmus were thought to be the functional alteration of the cerebral hemisphere and the brain stem. The examinations of gaze nystagmus and optokinetic nystagmus were harmless, simple and could be repeated at bed side easily, so these examinations were reliable for the expectation of the postoperative status of the brain stem as well as cerebral hemisphere and the necessity of neurosurgical examination.
在开颅手术前后于床边进行凝视和视动性眼球震颤检查。在名古屋大学医院接受颅内手术的120例患者中定期观察到凝视性眼球震颤。91例幕上病变患者中有16例、27例幕下病变患者中有24例出现术前未见的术后眼球震颤。这些术后眼球震颤持续3天至21天。对23例诊断为单侧病变的患者检查了自发性水平眼球震颤的方向状态和方向优势。在幕上病变的病例中，眼球震颤似乎以患侧为主，而在幕下病变的患者中，它倾向于以健侧为主。讨论了自发性和凝视性眼球震颤的机制。该研究无法确定幕上病变中的眼球震颤是由于大脑皮层的干扰还是脑干的继发性干扰引起的。幕下病变的术后眼球震颤可能是由术后水肿、手术损伤、循环障碍和缺氧引起的。在床边用手工制作的鼓进行视动性眼球震颤检查持续了几周，直到患者病情稳定。在52例患者中的大多数中，开颅术后水平视动性眼球震颤的频率降低，然后又逐渐增加。幕上和幕下病变均有类似观察结果。对30例诊断为单侧病变的患者检查了视动性方向优势。8例幕上病例显示健侧眼球震颤减少，2例幕下病例显示患侧眼球震颤减少。术后短暂凝视性眼球震颤和水平视动性眼球震颤的变化被认为是大脑半球和脑干的功能改变。凝视性眼球震颤和视动性眼球震颤检查无害、简单且可在床边轻松重复，因此这些检查对于预测脑干以及大脑半球的术后状态以及神经外科检查的必要性是可靠的。
