Cerebellar Oculomotor Signs

Three principal syndromes of cerebellar oculomotor disorders can be identified: (1) the syndrome of the dorsal vermis and underlying fastigial vermis, (2) the syndrome of the flocculus and paraflocculus, and (3) the syndrome of the nodulus. y , y Lesions of the dorsal vermis and fastigial nucleus cause saccadic dysmetria and mild deficits of smooth pursuit. Lesions of the nodulus are accompanied with prolongation of vestibular responses and periodic alternating nystagmus, which is a spontaneous horizontal nystagmus that changes direction every few minutes. Lesions of the flocculus and paraflocculus cause impaired smooth pursuit; gaze-evoked, rebound, and downbeat nystagmus; impaired optokinetic nystagmus; and disability to adjust the gain of the VOR. Other cerebellar oculomotor signs cannot be localized to specific cerebellar regions at present, such as square-wave jerks, upbeat nystagmus, and pendular oscillations. These three syndromes are frequently found in patients with degenerative forms of cerebellar ataxia. Cerebellar hemorrhage, tumors, and infarcts may all cause cerebellar eye signs by direct involvement of midline cerebellar structures. Medulloblastomas involving the nodulus and uvula are frequently associated with positional nystagmus. Downbeat nystagmus is frequently associated with paraneoplastic cerebellar ataxia.

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