Abstract Ocular motility defects occurring as a result of unilateral stereotactic thermal lesions in the midbrain pretectal areas have been observed in 16 patients. The preponderance of convergence defects leads to the conclusion that convergence function is not focally localized to the midline but is mediated more diffusely from pretectal regions of the midbrain. It appears as if midline structures are not the primary center for convergence. Miotic pupils in 15 patients suggests a diffuse association of accommodation and pupillary reaction which can be symmetrically affected by a unilateral lesion. The observation of skew deviation suggests that vertical gaze is also more diffusely organized in the dorsolateral midbrain. A unilateral stereotactic lesion can cause both bilateral paralysis of vertical gaze as well as skew deviation. References 1. Bender MB: Comments on the physiology and pathology of eye movements in the vertical plane . J Nerv Ment Dis 130:464, 1960.Crossref 2. Bender MB, Shanzer S: Oculomotor pathways defined by electric stimulation and lesions in the brainstem of the monkey , in Bender MB (ed): The Oculomotor System . New York, Harper & Row, 1964, p 128. 3. Hatcher MA Jr, Klintworth GK: The Sylvan aqueduct syndrome: A clinicopathologic study . Arch Neurol 15:215-221, 1966.Crossref 4. Nashold BS, Gills JP: Ocular signs from brain stimulation and lesions . Arch Ophthal 77:609-618, 1967.Crossref 5. Urist MJ: Surgery in horizontal strabismus . Amer J Ophthal 55:63, 1963. 6. Last RJ (ed): Eugene Wolff's Anatomy of the Eye and Orbit , ed 6. Philadelphia, WB Saunders Co, 1968, pp 281, 509. 7. Moses RA (ed): Adler's Physiology of the Eye: Clinical Application , ed 5. St. Louis, CV Mosby Co, 1970, pp 223, 224. 8. Warrick R: The so-called nucleus of convergence . Brain 78:92-116, 1955.Crossref 9. Cogan DG: Neurology of the Ocular Muscles , ed 2. Springfield, Ill, Charles C Thomas Publisher, 1956, p 134. 10. Smith JL, David NJ, Klintworth GK: Skew deviation . Neurology 14:96-105, 1964.Crossref
Archives of Ophthalmology – American Medical Association
Published: Sep 1, 1972
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