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Vaghi G, Vegezzi E, Bini P, Gastaldi M, Diamanti L, Marchioni E, Colnaghi S. A Case of Anti-Ma2 Encephalitis Presenting with Pendular Torsional Nystagmus. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1249-1253. [PMID: 37848701 PMCID: PMC11102397 DOI: 10.1007/s12311-023-01601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 10/19/2023]
Abstract
Antibodies against the neuronal protein Ma2 have been reported in a peculiar form of paraneoplastic encephalitis with prominent involvement of the limbic, brainstem, and diencephalic structures and usually associated with germ cell testicular, lung, or breast cancer. The diagnosis is frequently challenged by atypical clinical manifestations including parkinsonism, sleep disturbances, hypothalamic-pituitary dysfunctions, and motor neuron-like syndrome. In recent years, the advent of monoclonal antibodies targeting immune checkpoints has deeply changed the treatment of different tumors, especially melanoma and lung cancer. However, given their nature, an increasing number of neurological immune-related adverse events, including ocular motor abnormalities, have been described. Here, we report a woman with advanced non-small cell lung cancer treated with anti-PD-L1 durvalumab, presenting with an isolated pendular torsional nystagmus, in association with anti-Ma2 antibodies. This peculiar case widens our knowledge on the clinical presentation of anti-Ma2 encephalitis associated with checkpoint inhibitors.
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Affiliation(s)
- Gloria Vaghi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.
| | - Elisa Vegezzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Paola Bini
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
- Neuroimmunology Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Luca Diamanti
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Enrico Marchioni
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Colnaghi
- Neurology Unit, Dipartimento Funzionale Sperimentale Interaziendale di Neuroscienze, ASST, Pavia, Italy
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2
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Quitt PR, Brühschwein A, Matiasek K, Wielaender F, Karkamo V, Hytönen MK, Meyer-Lindenberg A, Dengler B, Leeb T, Lohi H, Fischer A. A hypomyelinating leukodystrophy in German Shepherd dogs. J Vet Intern Med 2021; 35:1455-1465. [PMID: 33734486 PMCID: PMC8163122 DOI: 10.1111/jvim.16085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/07/2021] [Accepted: 02/17/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Shaking puppy syndrome is commonly attributed to abnormal myelination of the central nervous system. HYPOTHESIS/OBJECTIVES To report the long-term clinical course and the imaging characteristics of hypomyelinating leukodystrophy in German Shepherd dogs. ANIMALS AND METHODS Three related litters with 11 affected dogs. RESULTS The 11 affected dogs experienced coarse, side-to-side tremors of the head and trunk, which interfered with normal goal-oriented movements and disappeared at rest. Signs were noticed shortly after birth. Nine dogs were euthanized, 3 dogs underwent pathological examination, and 2 littermates were raised by their breeder. Tremors improved gradually until 6 to 7 months of age. Adult dogs walked with severe residual pelvic limb ataxia. One dog developed epilepsy with tonic-clonic seizures at 15 months of age. Conventional magnetic resonance imaging (MRI) disclosed homogenous hyperintense signal of the entire subcortical white matter in 3 affected 7-week-old dogs and a hypointense signal in a presumably unaffected littermate. Subcortical white matter appeared isointense to gray matter at 15 and 27 weeks of age on repeated MRI. Abnormal white matter signal with failure to display normal gray-white matter contrast persisted into adulthood. Cerebellar arbor vitae was not visible at any time point. Clinical signs, MRI findings, and pathological examinations were indicative of a hypomyelinating leukodystrophy. All parents of the affected litters shared a common ancestor and relatedness of the puppies suggested an autosomal recessive mode of inheritance. CONCLUSION We describe a novel hypomyelinating leukodystrophy in German Shepherd dogs with a suspected inherited origin.
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Affiliation(s)
- Pia R Quitt
- Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, LMU Munich, Munich, Germany
| | - Andreas Brühschwein
- Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, LMU Munich, Munich, Germany
| | - Kaspar Matiasek
- Section of Clinical and Comparative Pathology, Faculty of Veterinary Medicine, LMU Munich, Munich, Germany
| | - Franziska Wielaender
- Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, LMU Munich, Munich, Germany
| | - Veera Karkamo
- Production and Companion Animal Pathology Section, Finnish Food Authority, Helsinki, Finland
| | - Marjo K Hytönen
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland.,Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Andrea Meyer-Lindenberg
- Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, LMU Munich, Munich, Germany
| | - Berett Dengler
- Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, LMU Munich, Munich, Germany
| | - Tosso Leeb
- Institute of Genetics, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Hannes Lohi
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland.,Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Andrea Fischer
- Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, LMU Munich, Munich, Germany
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3
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Jafari N, Golnik K, Shahriari M, Karimzadeh P, Jabbehdari S. Ophthalmologic Findings in Patients with Neuro-metabolic Disorders. J Ophthalmic Vis Res 2018; 13:34-38. [PMID: 29403587 PMCID: PMC5782454 DOI: 10.4103/jovr.jovr_242_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: We aimed to present the ophthalmic manifestations of neuro-metabolic disorders. Methods: Patients who were diagnosed with neuro-metabolic disorders in the Neurology Department of Mofid Pediatric Hospital in Tehran, Iran, between 2004 and 2014 were included in this study. Disorders were confirmed using clinical findings, neuroimaging, laboratory data, and genomic analyses. All enrolled patients were assessed for ophthalmological abnormalities. Results: A total of 213 patients with 34 different neuro-metabolic disorders were included. Ophthalmological abnormalities were observed in 33.5% of patients. Abnormal findings in the anterior segment included Kayser–Fleischer rings, congenital or secondary cataracts, and lens dislocation into the anterior chamber. Posterior segment (i.e., retina, vitreous body, and optic nerve) evaluation revealed retinitis pigmentosa, cherry-red spots, and optic atrophy. In addition, strabismus, nystagmus, and lack of fixation were noted during external examination. Conclusion: Ophthalmological examination and assessment is essential in patients that may exhibit neuro-metabolic disorders.
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Affiliation(s)
- Narjes Jafari
- Pediatric Neurology Research Center, Mofid Children Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Karl Golnik
- Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Mansoor Shahriari
- Department of Ophthalmology, Imam Hossein Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Karimzadeh
- Pediatric Neurology Research Center, Mofid Children Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sayena Jabbehdari
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
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4
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Oh EH, Lee JH, Shin JH, Kim HS, Kim JS, Kim HJ, Choi SY, Choi KD, Zee DS, Choi JH. Patterns and modulations of Pendular nystagmus in a family with hereditary spastic paraplegia. J Neurol Sci 2017; 383:169-173. [PMID: 29246608 DOI: 10.1016/j.jns.2017.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/20/2017] [Accepted: 11/14/2017] [Indexed: 11/19/2022]
Abstract
Hereditary spastic paraplegia (HSP) is characterized by progressive spasticity and weakness of the lower extremities. Additional findings include ataxia, extrapyramidal signs, and dementia. Pendular nystagmus (PN) has been reported in some subtypes of HSP caused by PLP1 (SPG2) or paraplegin (SPG7) mutation. To describe the patterns and modulation of PN in HSP, we performed eye movement recording using video-oculography in a Korean family with HSP and PN. The PN was convergent-divergent in the oblique plane with a frequency of 6 to 7Hz and maximum amplitude at about 1.5°. The nystagmus diminished briefly after blinks and horizontal saccades, and decreased during eccentric gaze and convergence. Horizontal saccades shifted the phase of the oscillations. During lateral gazes, the PN increased in the abducting eye, but decreased in the adducting eye. Vibratory stimuli decreased the nystagmus mostly in the left but not in the right eye. No pathogenic mutation was found in the genetic loci known for causing spastic paraplegia by whole-exome sequencing. The unusual features and modulation of PN in our patients with HSP emphasize the role of disconjugate and disjunctive capabilities of the brain in ocular motor control, and exemplify what can go wrong.
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Affiliation(s)
- Eun Hye Oh
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jae-Hyeok Lee
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jin-Hong Shin
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyang-Sook Kim
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seo-Young Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Republic of Korea
| | - Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Republic of Korea
| | - David S Zee
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, USA
| | - Jae-Hwan Choi
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
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5
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Neuro-Ophthalmic Manifestations of Pediatric Neurodegenerative Disease. J Neuroophthalmol 2017; 37 Suppl 1:S4-S13. [DOI: 10.1097/wno.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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6
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Juricek L, Carcaud J, Pelhaitre A, Riday TT, Chevallier A, Lanzini J, Auzeil N, Laprévote O, Dumont F, Jacques S, Letourneur F, Massaad C, Agulhon C, Barouki R, Beraneck M, Coumoul X. AhR-deficiency as a cause of demyelinating disease and inflammation. Sci Rep 2017; 7:9794. [PMID: 28851966 PMCID: PMC5575046 DOI: 10.1038/s41598-017-09621-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/24/2017] [Indexed: 12/29/2022] Open
Abstract
The Aryl hydrocarbon Receptor(AhR) is among the most important receptors which bind pollutants; however it also regulates signaling pathways independently of such exposure. We previously demonstrated that AhR is expressed during development of the central nervous system(CNS) and that its deletion leads to the occurrence of a congenital nystagmus. Objectives of the present study are to decipher the origin of these deficits, and to identify the role of the AhR in the development of the CNS. We show that the AhR-knockout phenotype develops during early infancy together with deficits in visual-information-processing which are associated with an altered optic nerve myelin sheath, which exhibits modifications in its lipid composition and in the expression of myelin-associated-glycoprotein(MAG), a cell adhesion molecule involved in myelin-maintenance and glia-axon interaction. In addition, we show that the expression of pro-inflammatory cytokines is increased in the impaired optic nerve and confirm that inflammation is causally related with an AhR-dependent decreased expression of MAG. Overall, our findings demonstrate the role of the AhR as a physiological regulator of myelination and inflammatory processes in the developing CNS. It identifies a mechanism by which environmental pollutants might influence CNS myelination and suggest AhR as a relevant drug target for demyelinating diseases.
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Affiliation(s)
- Ludmila Juricek
- INSERM UMR-S1124, Toxicologie Pharmacologie et Signalisation cellulaire, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Julie Carcaud
- CNRS UMR8119, Centre de Neurophysique, Physiologie, Pathologie, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Alice Pelhaitre
- INSERM UMR-S1124, Toxicologie Pharmacologie et Signalisation cellulaire, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Thorfinn T Riday
- CNRS FR 3636, Glia-Glia and Glia-Neuron Interactions Group, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Aline Chevallier
- INSERM UMR-S1124, Toxicologie Pharmacologie et Signalisation cellulaire, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Justine Lanzini
- CNRS UMR8638 Chimie Organique, Médicinale et Extractive et Toxicologie Expérimentale, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Nicolas Auzeil
- CNRS UMR8638 Chimie Organique, Médicinale et Extractive et Toxicologie Expérimentale, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Olivier Laprévote
- CNRS UMR8638 Chimie Organique, Médicinale et Extractive et Toxicologie Expérimentale, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Florent Dumont
- Plate-Forme Séquençage et Génomique, Institut Cochin, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Sebastien Jacques
- Plate-Forme Séquençage et Génomique, Institut Cochin, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Frank Letourneur
- Plate-Forme Séquençage et Génomique, Institut Cochin, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Charbel Massaad
- INSERM UMR-S1124, Toxicologie Pharmacologie et Signalisation cellulaire, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Cendra Agulhon
- CNRS FR 3636, Glia-Glia and Glia-Neuron Interactions Group, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Robert Barouki
- INSERM UMR-S1124, Toxicologie Pharmacologie et Signalisation cellulaire, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Mathieu Beraneck
- CNRS UMR8119, Centre de Neurophysique, Physiologie, Pathologie, Paris, France.,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France
| | - Xavier Coumoul
- INSERM UMR-S1124, Toxicologie Pharmacologie et Signalisation cellulaire, Paris, France. .,Université Paris Descartes, 45 rue des Saints-Pères, 75006, Paris, France.
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7
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Kang S, Shaikh AG. Acquired pendular nystagmus. J Neurol Sci 2017; 375:8-17. [PMID: 28320194 DOI: 10.1016/j.jns.2017.01.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 12/18/2016] [Accepted: 01/09/2017] [Indexed: 11/16/2022]
Abstract
Acquired pendular nystagmus is comprised of quasi-sinusoidal oscillations of the eyes significantly affecting gaze holding and clarity of vision. The most common causes of acquired pendular nystagmus include demyelinating disorders such as multiple sclerosis and the syndrome of ocular palatal tremor. However, several other deficits, such as pharmacological intoxication, metabolic and genetic disorders, and granulomatous disorders can lead to syndromes mimicking acquired pendular nystagmus. Study of the kinematic features of acquired pendular nystagmus has suggested a putative pathophysiology of an otherwise mysterious neurological disorder. Here we review clinical features of neurological deficits that co-occur with acquired pendular nystagmus. Subsequent discussion of the pathophysiology of individual forms of pendular nystagmus speculates on mechanisms of the underlying disease while providing insights into pharmacotherapy of nystagmus.
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Affiliation(s)
- Sarah Kang
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA; Daroff-DelOsso Ocular Motility Laboratory, Neurology Service, Louis Stoke VA Medical Center, Cleveland, OH, USA
| | - Aasef G Shaikh
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA; Daroff-DelOsso Ocular Motility Laboratory, Neurology Service, Louis Stoke VA Medical Center, Cleveland, OH, USA.
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8
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Beh SC, Frohman TC, Frohman EM. Neuro-ophthalmic Manifestations of Cerebellar Disease. Neurol Clin 2014; 32:1009-80. [DOI: 10.1016/j.ncl.2014.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Shin C Beh
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Teresa C Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Elliot M Frohman
- Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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9
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Bassani R, Pareyson D, D'Incerti L, Di Bella D, Taroni F, Salsano E. Pendular nystagmus in hypomyelinating leukodystrophy. J Clin Neurosci 2013; 20:1443-5. [PMID: 23845262 DOI: 10.1016/j.jocn.2012.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 11/10/2012] [Indexed: 10/26/2022]
Abstract
We report the case of a 49-year old woman affected by hypomyelinating leukodystrophy. She presented with typical pendular nystagmus that was analyzed with video-oculography which is provided in the supplementary material of the report. The pendular nystagmus was accompanied by upper limb ataxia on the index-to-nose test. The video was partly recorded with a slow-motion technique in order to better demonstrate the ataxia and the pendular nystagmus. The brain MRI demonstrated a characteristic pattern of hypomyelination. Pendular nystagmus is a key clinical sign that contributes to the diagnosis of CNS hypomyelination when a leukodystrophic pattern is observed on brain MRI.
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Affiliation(s)
- R Bassani
- Department of Neurological Sciences, Ospedale "G. Salvini", via Forlanini 121, Garbagnate Milanese, Italy; Oto-neurology Service, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico, Istituto Neurologico Carlo Besta, Milano, Italy.
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10
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Abstract
We review current concepts of nystagmus and saccadic oscillations, applying a pathophysiological approach. We begin by discussing how nystagmus may arise when the mechanisms that normally hold gaze steady are impaired. We then describe the clinical and laboratory evaluation of patients with ocular oscillations. Next, we systematically review the features of nystagmus arising from peripheral and central vestibular disorders, nystagmus due to an abnormal gaze-holding mechanism (neural integrator), and nystagmus occurring when vision is compromised. We then discuss forms of nystagmus for which the pathogenesis is not well understood, including acquired pendular nystagmus and congenital forms of nystagmus. We then summarize the spectrum of saccadic disorders that disrupt steady gaze, from intrusions to flutter and opsoclonus. Finally, we review current treatment options for nystagmus and saccadic oscillations, including drugs, surgery, and optical methods. Examples of each type of nystagmus are provided in the form of figures.
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Affiliation(s)
- Matthew J Thurtell
- Departments of Neurology and Daroff-Dell'Osso Laboratory, Veterans Affairs Medical Center and University Hospitals, Case Western Reserve University, Cleveland, OH 44106, USA
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11
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12
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Abstract
Proper evaluation and treatment of acquired nystagmus requires accurate characterization of nystagmus type and visual effects. This review addresses important historical and examination features of nystagmus and current concepts of pathogenesis and treatment of gaze-evoked nystagmus, nystagmus due to vision loss, acquired pendular nystagmus, peripheral and central vestibular nystagmus, and periodic alternating nystagmus.
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Affiliation(s)
- Janet C Rucker
- Department of Neurological Sciences, Rush University, Chicago, IL 60612, USA.
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13
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Affiliation(s)
- Marc J Dinkin
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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14
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Albera R, Luda E, Canale G, Machetta G, Lacilla M, Faida M, Locatelli F. Cyclosporine a as a possible cause of upbeating nystagmus. Neuroophthalmology 1997. [DOI: 10.3109/01658109709044660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Abstract
The Neurophysiological characteristics of Pelizaeus-Marzbacher disease (PMD) were studied in four Japanese patients aged between 5 and 13 years. Pendular spontaneous nystagmus was always recorded with a frequency between 2.5 and 4 Hz, and abnormal saccades with an almost twofold prolongation in onset time and 50% decrease in velocity were noted. Brainstem auditory evoked potentials consistently demonstrated severely altered waves II to V, following a normal wave I, despite normal hearing acuity. Somatosensory evoked potentials (SEPs) were always absent between brainstem components and early cortical responses. Late cortical components of SEPs and visual evoked potentials with significantly prolonged latencies were recorded in the three younger cases having normal sensory and visual acuity (N35 of SEP, 73.1 +/- 2.1 ms; N75 of VEP, 129.0 +/- 12.7 ms; mean +/- S.D.), while these peaks were absent in the oldest case having the most severe handicap. In motor evoked potentials (MEPs), R1 of blink reflex with significantly prolonged latency (14.9 +/- 1.48ms) was always obtained, and no subsequent R2 was elicited. Magnetic transcortical stimulation elicited no MEPs of the thenar even in the facilitating condition on voluntary contraction despite mild weakness of the thenar, while normal MEPs were always elicited on cervical stimulation. These electrophysiological findings were consistent with extensive conduction slowing involving the brainstem to the cerebrum, which seemed to be accompanied by conduction block in motor systems rather than sensory systems. Although each of the results was not specific, in combination they suggested the characteristics of diffuse brain dysmyelination in PMD.
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Affiliation(s)
- A Nezu
- Department of Pediatrics, Yokohama City University, School of Medicine, Japan
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16
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Huygen PL, Verhagen WI, Renier WO. Oculomotor and vestibular anomalies in Pelizaeus-Merzbacher disease: a study on a kindred with 2 affected and 3 normal males, 3 obligate and 8 possible carriers. J Neurol Sci 1992; 113:17-25. [PMID: 1469451 DOI: 10.1016/0022-510x(92)90259-n] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Two males suffering from Pelizaeus-Merzbacher disease were examined, one at the age of 1 year 4 months and at the age of 7 years, and the other at the age of 7 years 8 months. The former had spontaneous vertical pendular nystagmus. He also showed horizontal "micronystagmus", present only at the age of 1 year, which might be similar to "voluntary nystagmus". Both males had jerky bilateral gaze-evoked nystagmus, defective smooth pursuit and optokinetic responses and a hyporeactive vestibulo-ocular reflex (VOR). All three obligate carriers exhibited typical VOR disinhibition in the two horizontal nystagmus directions, which may be a distinctive feature. This feature was also found in one of the 7 possible carriers examined and was not observed in the 3 non-affected males, who had normal oculomotor responses.
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Affiliation(s)
- P L Huygen
- Department of Otolaryngology, University Hospital, Nijmegen, The Netherlands
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17
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Millichap JG. Nystagmus of Pelizaeus-Merzbacher Disease. Pediatr Neurol Briefs 1991. [DOI: 10.15844/pedneurbriefs-5-2-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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