Vestibular and Ocular Motor Properties in Lateral Medullary Stroke Critically Depend on the Level of the Medullary Lesion
Background: Lateral medullary stroke (LMS) results in a characteristic pattern of brainstem signs including ocular motor and vestibular deficits. Thus, an impaired angular vestibulo-ocular reflex (aVOR) may be found if the vestibular nuclei are affected.Objective: We aimed to characterize the freque...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-06-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2020.00390/full |
| _version_ | 1818775425187315712 |
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| author | Seung-Han Lee Jae-Myung Kim Bernhard Schuknecht Bernhard Schuknecht Alexander Andrea Tarnutzer Alexander Andrea Tarnutzer |
| author_facet | Seung-Han Lee Jae-Myung Kim Bernhard Schuknecht Bernhard Schuknecht Alexander Andrea Tarnutzer Alexander Andrea Tarnutzer |
| author_sort | Seung-Han Lee |
| collection | DOAJ |
| description | Background: Lateral medullary stroke (LMS) results in a characteristic pattern of brainstem signs including ocular motor and vestibular deficits. Thus, an impaired angular vestibulo-ocular reflex (aVOR) may be found if the vestibular nuclei are affected.Objective: We aimed to characterize the frequency and pattern of vestibular and ocular-motor deficits in patients with LMS.Methods: Patients with MR-confirmed acute/subacute unilateral LMS from a stroke registry were included and a bedside neuro-otological examination was performed. Video-oculography and video-based head-impulse testing (vHIT) was obtained and semicircular canal function was determined. The lesion location/extension as seen on MRI was rated and involvement of the vestibular nuclei was judged.Results: Seventeen patients with LMS (age = 59.4 ± 14.3 years) were included. All patients had positive H.I.N.T.S. vHIT showed mild-to-moderate aVOR impairments in three patients (ipsilesional = 1; ipsilesional and contralesional = 1; contralesional = 1). Spontaneous nystagmus (n = 10/15 patients) was more often beating contralesionally than ipsilesionally (6 vs. 3) and was accompanied by upbeat nystagmus in four patients. Head-shaking nystagmus was noted in seven subjects, ipsilesionally beating in six and down-beating in one. On brain MRI, damage of the most caudal parts of the medial and/or inferior vestibular nucleus was noted in 13 patients. Only those two patients with lesions affecting the rostral medulla oblongata demonstrated an ipsilaterally impaired aVOR.Conclusions: While subtle ocular motor signs pointed to damage of the central–vestibular pathways in all 17 patients, aVOR deficits were infrequent, restricted to those patients with rostral medullary lesions and, if present, mild to moderate only. This can be explained by lesions located too far caudally and too far ventrally to substantially affect the vestibular nuclei. |
| first_indexed | 2024-12-18T10:56:50Z |
| format | Article |
| id | doaj.art-35cbe7b44060467fa8bdd3f42a35621d |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-18T10:56:50Z |
| publishDate | 2020-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-35cbe7b44060467fa8bdd3f42a35621d2022-12-21T21:10:18ZengFrontiers Media S.A.Frontiers in Neurology1664-22952020-06-011110.3389/fneur.2020.00390521748Vestibular and Ocular Motor Properties in Lateral Medullary Stroke Critically Depend on the Level of the Medullary LesionSeung-Han Lee0Jae-Myung Kim1Bernhard Schuknecht2Bernhard Schuknecht3Alexander Andrea Tarnutzer4Alexander Andrea Tarnutzer5Department of Neurology, Chonnam National University Hospital and Chonnam National University Medical School, Gwangju, South KoreaDepartment of Neurology, Chonnam National University Hospital and Chonnam National University Medical School, Gwangju, South KoreaMedical Radiological Institute, Zurich, SwitzerlandFaculty of Medicine, University of Zurich, Zurich, SwitzerlandFaculty of Medicine, University of Zurich, Zurich, SwitzerlandNeurology, Cantonal Hospital of Baden, Baden, SwitzerlandBackground: Lateral medullary stroke (LMS) results in a characteristic pattern of brainstem signs including ocular motor and vestibular deficits. Thus, an impaired angular vestibulo-ocular reflex (aVOR) may be found if the vestibular nuclei are affected.Objective: We aimed to characterize the frequency and pattern of vestibular and ocular-motor deficits in patients with LMS.Methods: Patients with MR-confirmed acute/subacute unilateral LMS from a stroke registry were included and a bedside neuro-otological examination was performed. Video-oculography and video-based head-impulse testing (vHIT) was obtained and semicircular canal function was determined. The lesion location/extension as seen on MRI was rated and involvement of the vestibular nuclei was judged.Results: Seventeen patients with LMS (age = 59.4 ± 14.3 years) were included. All patients had positive H.I.N.T.S. vHIT showed mild-to-moderate aVOR impairments in three patients (ipsilesional = 1; ipsilesional and contralesional = 1; contralesional = 1). Spontaneous nystagmus (n = 10/15 patients) was more often beating contralesionally than ipsilesionally (6 vs. 3) and was accompanied by upbeat nystagmus in four patients. Head-shaking nystagmus was noted in seven subjects, ipsilesionally beating in six and down-beating in one. On brain MRI, damage of the most caudal parts of the medial and/or inferior vestibular nucleus was noted in 13 patients. Only those two patients with lesions affecting the rostral medulla oblongata demonstrated an ipsilaterally impaired aVOR.Conclusions: While subtle ocular motor signs pointed to damage of the central–vestibular pathways in all 17 patients, aVOR deficits were infrequent, restricted to those patients with rostral medullary lesions and, if present, mild to moderate only. This can be explained by lesions located too far caudally and too far ventrally to substantially affect the vestibular nuclei.https://www.frontiersin.org/article/10.3389/fneur.2020.00390/fullvideo head impulse testhead-shaking nystagmusgaze-evoked nystagmusHINTSWallenberg syndrome |
| spellingShingle | Seung-Han Lee Jae-Myung Kim Bernhard Schuknecht Bernhard Schuknecht Alexander Andrea Tarnutzer Alexander Andrea Tarnutzer Vestibular and Ocular Motor Properties in Lateral Medullary Stroke Critically Depend on the Level of the Medullary Lesion Frontiers in Neurology video head impulse test head-shaking nystagmus gaze-evoked nystagmus HINTS Wallenberg syndrome |
| title | Vestibular and Ocular Motor Properties in Lateral Medullary Stroke Critically Depend on the Level of the Medullary Lesion |
| title_full | Vestibular and Ocular Motor Properties in Lateral Medullary Stroke Critically Depend on the Level of the Medullary Lesion |
| title_fullStr | Vestibular and Ocular Motor Properties in Lateral Medullary Stroke Critically Depend on the Level of the Medullary Lesion |
| title_full_unstemmed | Vestibular and Ocular Motor Properties in Lateral Medullary Stroke Critically Depend on the Level of the Medullary Lesion |
| title_short | Vestibular and Ocular Motor Properties in Lateral Medullary Stroke Critically Depend on the Level of the Medullary Lesion |
| title_sort | vestibular and ocular motor properties in lateral medullary stroke critically depend on the level of the medullary lesion |
| topic | video head impulse test head-shaking nystagmus gaze-evoked nystagmus HINTS Wallenberg syndrome |
| url | https://www.frontiersin.org/article/10.3389/fneur.2020.00390/full |
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