Eye movements in vestibular disorders

A. Kheradmand, A. I. Colpak, D. S. Zee

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The differential diagnosis of patients with vestibular symptoms usually begins with the question: is the lesion central or is it peripheral? The answer commonly emerges from a careful examination of eye movements, especially when the lesion is located in otherwise clinically silent areas of the brain such as the vestibular portions of the cerebellum (flocculus, paraflocculus which is called the tonsils in humans, nodulus, and uvula) and the vestibular nuclei as well as immediately adjacent areas (the perihypoglossal nuclei and the paramedian nuclei and tracts). The neural circuitry that controls vestibular eye movements is intertwined with a larger network within the brainstem and cerebellum that also controls other types of conjugate eye movements. These include saccades and pursuit as well as the mechanisms that enable steady fixation, both straight ahead and in eccentric gaze positions. Navigating through this complex network requires a thorough knowledge about all classes of eye movements to help localize lesions causing a vestibular disorder. Here we review the different classes of eye movements and how to examine them, and then describe common ocular motor findings associated with central vestibular lesions from both a topographic and functional perspective.

Original languageEnglish (US)
Title of host publicationHandbook of Clinical Neurology
PublisherElsevier B.V.
Pages103-117
Number of pages15
DOIs
StatePublished - 2016

Publication series

NameHandbook of Clinical Neurology
Volume137
ISSN (Print)0072-9752
ISSN (Electronic)2212-4152

Keywords

  • brainstem
  • cerebellum
  • eye movement
  • gaze-holding
  • medulla
  • midbrain
  • nystagmus
  • pons
  • pursuit
  • saccade

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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