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Journal of the Korean Neurological Association 2005;23(1): 62-70.
안구개진전의 3차원적 안구운동분석
문소영, 김지수 최광동 전종은 박성호 황정민* 김근영† 김희찬†
서울대학교 의과대학 신경과학교실, 안과학교실*, 의공학교실†
3-Dimensional Analyses of Eye Motion in Oculopalatal Tremor
So Young Moon
Departments of Neurology, Ophthalmology*, and Biomedical Engineering†, Seoul National University College of Medicine, Seoul, Korea
Background: Oculopalatal tremor (OPT) is a delayed complication of damage to the dentato-rubro-olivary pathway (Guillain-Mollaret triangle) and subsequent hypertrophic olivary degeneration. Mixed torsional-vertical pendular nystagmus in OPT has been considered to signify unilateral brainstem damage while symmetrical vertical nystagmus has been regarded to indicate bilateral disease. However, 3-dimensional oculographic analysis of OPT has been sparse.
Methods: In 8 patients with OPT; binocular 3-dimensional analyses of ocular oscillations were performed by using a magnetic search coil technique. Lateralization of the lesions was determined by the imaged olivary hypertrophy in the MRI.
Results: One patient had conjugate vertical pendular nystagmus and four showed mixed torsional-vertical pendular nystagmus. Two patients showed mixed horizontal-torsional-vertical nystagmus. One patient had predominantly horizontal pendular nystagmus. MRI demonstrated increased signal or hypertrophy of the inferior olivary nucleus, unilateral in six and bilateral in two. Unilateral olivary changes were associated with mixed torsional-vertical nystagmus in three patients, mixed horizontal-torsional-vertical nystagmus in another two patients, and predominantly horizontal pendular nystagmus in the remaining one patient. Bilateral olivary changes were visible in one patient with conjugate vertical pendular nystagmus and in the other patient with mixed torsional-vertical nystagmus. Palatal tremor appeared to be symmetrical in all patients.
Conclusions: Three-dimensional analyses of OPT indicate that conjugate vertical and mixed torsional-vertical pendular nystagmus do not correspond to the laterality of signal changes in the inferior olivary nucleus. Ocular oscillations often have all the vertical, horizontal and torsional components.KeyWords:Pendular nystagmus, Oculopalatal tremor, Palatal tremor, Inferior olivary nucleus, MRI
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