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Ji Soo Kim - One of the best experts on this subject based on the ideXlab platform.
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reader response teaching video neuroimages pulsatile proptosis and wall eyed bilateral Internuclear Ophthalmoplegia
Neurology, 2018Co-Authors: Taekyung Lee, Seung-han Lee, Eeksung Lee, Ji Soo KimAbstract:We read with interest the Papageorgiou et al.1 Teaching Video NeuroImage on pulsatile proptosis and wall-eyed bilateral Internuclear Ophthalmoplegia. While this is a well-written case report with a good quality video, we offer an alternative interpretation of the MRI findings. At the pontine level, the medial longitudinal fasciculus (MLF) is situated beneath the floor of the fourth ventricle on either side of the midline,2 and lesions involving bilateral MLFs can cause wall-eyed bilateral Internuclear Ophthalmoplegia (WEBINO).3 However, the lesion that the authors indicated with the arrow on the T2-weighted MRI (figure, white arrow)1 is located more anteriorly compared to the area of the MLF on MRIs in previous reports3 and on anatomic templates.2 In addition, the lesion indicated appears chronic given the strong high signal intensity, similar to that of the CSF, even though the interval from the symptom onset to MRI was not provided. Instead, we propose that the symmetric high signal intensity lesions just beneath the facial colliculi were responsible for WEBINO in this patient (figure, black arrow added).
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author response impaired vestibular responses in Internuclear Ophthalmoplegia association and dissociation
Neurology, 2018Co-Authors: Ji Soo KimAbstract:I thank Dr. Johnston for her interest in our article and helpful comments on the mechanisms of impaired vestibulo-ocular reflex (VOR) during head impulses in patients with isolated unilateral Internuclear Ophthalmoplegia (INO).1
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impaired vestibular responses in Internuclear Ophthalmoplegia association and dissociation
Neurology, 2017Co-Authors: Seo Young Choi, Hyo Jung Kim, Ji Soo KimAbstract:Objective: To determine the role of the medial longitudinal fasciculus (MLF) in conveying vestibular signals. Methods: In 10 patients with isolated acute unilateral Internuclear Ophthalmoplegia (INO) due to an acute stroke, we performed comprehensive vestibular evaluation using video-oculography, head impulse tests with a magnetic search coil technique, bithermal caloric tests, tests for the ocular tilt reaction, and measurements of subjective visual vertical and cervical and ocular vestibular evoked myogenic potentials (VEMPs). Results: The head impulse gain of the vestibulo-ocular reflex (VOR) was decreased invariably for the contralesional posterior canal (PC) (n = 9; 90%) and usually for the ipsilesional horizontal canal (n = 5; 50%). At least one component of contraversive ocular tilt reaction (n = 9) or contraversive tilt of the subjective visual vertical (n = 7) were common along with ipsitorsional nystagmus (n = 5). Cervical or ocular VEMPs were abnormal in 5 patients. Conclusions: The MLF serves as the main passage for the high-acceleration VOR from the contralateral PC. The associations and dissociations of the vestibular dysfunction in our patients indicate variable combinations of damage to the vestibular fibers ascending or descending in the MLF even in strokes causing isolated unilateral INO.
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pure upbeat nystagmus in association with bilateral Internuclear Ophthalmoplegia
Journal of the Neurological Sciences, 2012Co-Authors: Jaehwan Choi, Kwang Dong Choi, Ji Soo Kim, Nayeon Jung, Minji Kim, Dae Soo JungAbstract:A 66-year-old man developed primary position upbeat nystagmus and bilateral Internuclear Ophthalmoplegia (INO). Video-oculography showed primary position upbeat nystagmus with exponentially decreasing slow phases, which disappeared in darkness. Brain MRI disclosed enhancing lesions involving bilateral dorsomedial pons extending from the middle to upper portion. Upbeat nystagmus in association with bilateral INO may be attributed by the damage of the cell groups of the paramedian tracts (PMT), the projections from the interstitial nucleus of Cajal (INC) to PMT, or the connections between INC and the nucleus of Roller.
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Patterns of dissociate torsional-vertical nystagmus in Internuclear Ophthalmoplegia.
Annals of the New York Academy of Sciences, 2011Co-Authors: Seong-hae Jeong, Eung Kyu Kim, Jun Lee, Kwang Dong Choi, Ji Soo KimAbstract:To explore the patterns and mechanisms of jerky seesaw nystagmus in Internuclear Ophthalmoplegia (INO), we analyzed the nystagmus patterns in 33 patients with dissociated torsional-vertical nystagmus and INO. In 11 (33%) patients, the nystagmus was ipsiversive torsional in both eyes with vertical components in the opposite directions. In contrast, 18 (55%) patients showed ipsiversive torsional nystagmus with a larger upbeat component in the contralesional eye. Four (12%) patients exhibited ipsiversive torsional nystagmus with a greater downbeat component in the ipsilesional eye. At least one component of contraversive ocular tilt reaction was associated in most patients (30/33, 91%). The patterns of jerky seesaw nystagmus in INO suggest a disruption of neural pathways from the contralateral vertical semicircular canals with or without concomitant damage to the fibers from the contralateral utricle in or near the medial longitudinal fasciculus.
Steven Galetta - One of the best experts on this subject based on the ideXlab platform.
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editors note teaching video neuroimages pulsatile proptosis and wall eyed bilateral Internuclear Ophthalmoplegia
Neurology, 2018Co-Authors: Chafic Karam, Steven GalettaAbstract:Commenting on “Teaching Video NeuroImages: Pulsatile proptosis and wall-eyed bilateral Internuclear Ophthalmoplegia,” Lee et al. offer an alternative interpretation of the MRI findings. They explain that the lesion suggested by the authors is chronic in nature and too anterior in the pons. They propose that the more likely explanation for the patient's wall-eyed bilateral Internuclear Ophthalmoplegia is the symmetric high-signal intensity lesions just beneath the facial colliculi. Authors Papageorgiou et al. reviewed the diffusion-weighted MRI of their patient and found that it showed a focal area of restricted diffusion at the midline of the pontine tegmentum beneath the floor of the fourth ventricle, which involves the medial longitudinal fasciculus bilaterally as correctly suggested by Lee et al. A correction appears on page 900. Commenting on “Teaching Video NeuroImages: Pulsatile proptosis and wall-eyed bilateral Internuclear Ophthalmoplegia,” Lee et al. offer an alternative interpretation of the MRI findings. They explain that the lesion suggested by the authors is chronic in nature and too anterior in the pons.
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editors note impaired vestibular responses in Internuclear Ophthalmoplegia association and dissociation
Neurology, 2018Co-Authors: Chafic Karam, Steven GalettaAbstract:In “Impaired vestibular responses in Internuclear Ophthalmoplegia: Association and dissociation,” Choi et al. determined that the medial longitudinal fasciculus (MLF) serves as the main passage for the high-acceleration vestibulo-ocular reflex (VOR) from the contralateral posterior canal. They also concluded that the associations and dissociations of the vestibular dysfunction indicate variable combinations of damage to the vestibular fibers ascending or descending in the MLF in strokes causing isolated unilateral Internuclear Ophthalmoplegia (INO). Dr. Johnston raises concerns regarding these conclusions. Based on her experience, horizontal VOR latencies are normal in patients with INO, implying integrity of direct VOR. She explained that undamaged fibers in MLF or extrafascicular pathways can still initiate the VOR without delay. Dr. Kim, senior author of the study, points out, in Dr. Johnston's study, that the VOR was recorded only in the eye on the lesion side by adopting lower velocity and acceleration of head motion and did not specify the lesion extent or INO as an isolated finding. He also adds that her suggestion does not explain the preservation of the head impulse VOR for the ipsilesional anterior canal in the presence of impairments for other canals, and impaired VOR gains in the eye on the contralesional side in patients with strictly isolated unilateral INO. These findings support separate brainstem pathways for posterior and anterior canal projections pertaining to high acceleration stimuli. In “Impaired vestibular responses in Internuclear Ophthalmoplegia: Association and dissociation,” Choi et al. determined that the medial longitudinal fasciculus (MLF) serves as the main passage for the high-acceleration vestibulo-ocular reflex (VOR) from the contralateral posterior canal. They also concluded that the associations and dissociations of the vestibular dysfunction indicate variable combinations of damage to the vestibular fibers ascending or descending in the MLF in strokes causing isolated unilateral Internuclear Ophthalmoplegia (INO).
Lippincott Williams Wilkins - One of the best experts on this subject based on the ideXlab platform.
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teaching video neuroimages pulsatile proptosis and wall eyed bilateral Internuclear Ophthalmoplegia
Neurology, 2018Co-Authors: Lippincott Williams WilkinsAbstract:In the Teaching Video NeuroImage “Pulsatile proptosis and wall-eyed bilateral Internuclear Ophthalmoplegia” by Papageorgiou et al.,1 there is an error in the arrow placement in figure 2. Please see the correct version below. The authors regret the error.
Chafic Karam - One of the best experts on this subject based on the ideXlab platform.
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editors note teaching video neuroimages pulsatile proptosis and wall eyed bilateral Internuclear Ophthalmoplegia
Neurology, 2018Co-Authors: Chafic Karam, Steven GalettaAbstract:Commenting on “Teaching Video NeuroImages: Pulsatile proptosis and wall-eyed bilateral Internuclear Ophthalmoplegia,” Lee et al. offer an alternative interpretation of the MRI findings. They explain that the lesion suggested by the authors is chronic in nature and too anterior in the pons. They propose that the more likely explanation for the patient's wall-eyed bilateral Internuclear Ophthalmoplegia is the symmetric high-signal intensity lesions just beneath the facial colliculi. Authors Papageorgiou et al. reviewed the diffusion-weighted MRI of their patient and found that it showed a focal area of restricted diffusion at the midline of the pontine tegmentum beneath the floor of the fourth ventricle, which involves the medial longitudinal fasciculus bilaterally as correctly suggested by Lee et al. A correction appears on page 900. Commenting on “Teaching Video NeuroImages: Pulsatile proptosis and wall-eyed bilateral Internuclear Ophthalmoplegia,” Lee et al. offer an alternative interpretation of the MRI findings. They explain that the lesion suggested by the authors is chronic in nature and too anterior in the pons.
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editors note impaired vestibular responses in Internuclear Ophthalmoplegia association and dissociation
Neurology, 2018Co-Authors: Chafic Karam, Steven GalettaAbstract:In “Impaired vestibular responses in Internuclear Ophthalmoplegia: Association and dissociation,” Choi et al. determined that the medial longitudinal fasciculus (MLF) serves as the main passage for the high-acceleration vestibulo-ocular reflex (VOR) from the contralateral posterior canal. They also concluded that the associations and dissociations of the vestibular dysfunction indicate variable combinations of damage to the vestibular fibers ascending or descending in the MLF in strokes causing isolated unilateral Internuclear Ophthalmoplegia (INO). Dr. Johnston raises concerns regarding these conclusions. Based on her experience, horizontal VOR latencies are normal in patients with INO, implying integrity of direct VOR. She explained that undamaged fibers in MLF or extrafascicular pathways can still initiate the VOR without delay. Dr. Kim, senior author of the study, points out, in Dr. Johnston's study, that the VOR was recorded only in the eye on the lesion side by adopting lower velocity and acceleration of head motion and did not specify the lesion extent or INO as an isolated finding. He also adds that her suggestion does not explain the preservation of the head impulse VOR for the ipsilesional anterior canal in the presence of impairments for other canals, and impaired VOR gains in the eye on the contralesional side in patients with strictly isolated unilateral INO. These findings support separate brainstem pathways for posterior and anterior canal projections pertaining to high acceleration stimuli. In “Impaired vestibular responses in Internuclear Ophthalmoplegia: Association and dissociation,” Choi et al. determined that the medial longitudinal fasciculus (MLF) serves as the main passage for the high-acceleration vestibulo-ocular reflex (VOR) from the contralateral posterior canal. They also concluded that the associations and dissociations of the vestibular dysfunction indicate variable combinations of damage to the vestibular fibers ascending or descending in the MLF in strokes causing isolated unilateral Internuclear Ophthalmoplegia (INO).
Ian S. Curthoys - One of the best experts on this subject based on the ideXlab platform.
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vestibulo ocular reflex pathways in Internuclear Ophthalmoplegia
Annals of Neurology, 1999Co-Authors: Phillip D. Cremer, Americo A. Migliaccio, Michael G Halmagyi, Ian S. CurthoysAbstract:We measured the vestibulo-ocular reflex (VOR) during head impulses in a patient with right-sided Internuclear Ophthalmoplegia. Head impulses are rapid, passive, high-acceleration, low-amplitude head rotations in the direction of a particular semicircular canal (SCC). Adduction of the right eye was abnormally slow during right lateral SCC head impulses. The VOR during left posterior SCC impulses was severely deficient in both eyes, but the VOR during left anterior SCC impulses was only slightly deficient. We suggest that the vertical vestibulo-ocular pathways in humans are connected in SCC-plane coordinates, not the traditional roll and pitch coordinates, and that anterior SCC signals do not travel exclusively in the medial longitudinal fasciculus.
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Vestibulo‐ocular reflex pathways in Internuclear Ophthalmoplegia
Annals of neurology, 1999Co-Authors: Phillip D. Cremer, Americo A. Migliaccio, G. Michael Halmagyi, Ian S. CurthoysAbstract:We measured the vestibulo-ocular reflex (VOR) during head impulses in a patient with right-sided Internuclear Ophthalmoplegia. Head impulses are rapid, passive, high-acceleration, low-amplitude head rotations in the direction of a particular semicircular canal (SCC). Adduction of the right eye was abnormally slow during right lateral SCC head impulses. The VOR during left posterior SCC impulses was severely deficient in both eyes, but the VOR during left anterior SCC impulses was only slightly deficient. We suggest that the vertical vestibulo-ocular pathways in humans are connected in SCC-plane coordinates, not the traditional roll and pitch coordinates, and that anterior SCC signals do not travel exclusively in the medial longitudinal fasciculus.
