Saccadic palsy after cardiac surgery: Characteristics and pathogenesis

David Solomon, Stefano Ramat, Robert L. Tomsak, Stephen G. Reich, Robert K. Shin, David Samuel Zee, R. John Leigh

Research output: Contribution to journalArticle

Abstract

Objective: To characterize the syndrome of saccadic palsy that may follow cardiac surgery, and to interpret the findings using current concepts of the neurobiology of fast eye movements. Methods: Using the magnetic search coil technique, we measured eye, eyelid, and head movements of 10 patients who developed selective palsy of saccades after cardiac surgery. Results: Patients showed varying degrees of slowing and hypometria of saccades in the vertical plane or both horizontal and vertical planes, with complete loss of all saccades in one patient. Quick phases of nystagmus were also affected, but smooth pursuit, vergence, and the vestibuloocular reflex were usually spared. The smallest saccades were less slowed than larger saccades. Affected patients were visually disabled by loss of ability to voluntarily shift their direction of gaze. Blinks and head thrusts modestly improved the range and speed of voluntary movement. The syndrome usually followed aortic valve replacement. Common accompanying features included dysarthria, labile emotions, and unsteady gait. The saccadic palsy either improved during the early part of the course or remained static. Interpretation: Selective loss of all forms of saccades, with sparing of other eye movements, indicates malfunction of the brainstem machinery that generates saccades. A current model of brainstem circuits could account for both hypometria and slowing. This syndrome and the visual disability it causes often go unrecognized unless saccades are systematically tested at the bedside.

Original languageEnglish (US)
Pages (from-to)355-365
Number of pages11
JournalAnnals of Neurology
Volume63
Issue number3
DOIs
StatePublished - Mar 2008

Fingerprint

Saccades
Paralysis
Thoracic Surgery
Eye Movements
Brain Stem
Neurologic Gait Disorders
Smooth Pursuit
Vestibulo-Ocular Reflex
Dysarthria
Head Movements
Aptitude
Neurobiology
Eyelids
Aortic Valve
Emotions
Head

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Solomon, D., Ramat, S., Tomsak, R. L., Reich, S. G., Shin, R. K., Zee, D. S., & Leigh, R. J. (2008). Saccadic palsy after cardiac surgery: Characteristics and pathogenesis. Annals of Neurology, 63(3), 355-365. https://doi.org/10.1002/ana.21201

Saccadic palsy after cardiac surgery : Characteristics and pathogenesis. / Solomon, David; Ramat, Stefano; Tomsak, Robert L.; Reich, Stephen G.; Shin, Robert K.; Zee, David Samuel; Leigh, R. John.

In: Annals of Neurology, Vol. 63, No. 3, 03.2008, p. 355-365.

Research output: Contribution to journalArticle

Solomon, D, Ramat, S, Tomsak, RL, Reich, SG, Shin, RK, Zee, DS & Leigh, RJ 2008, 'Saccadic palsy after cardiac surgery: Characteristics and pathogenesis', Annals of Neurology, vol. 63, no. 3, pp. 355-365. https://doi.org/10.1002/ana.21201
Solomon, David ; Ramat, Stefano ; Tomsak, Robert L. ; Reich, Stephen G. ; Shin, Robert K. ; Zee, David Samuel ; Leigh, R. John. / Saccadic palsy after cardiac surgery : Characteristics and pathogenesis. In: Annals of Neurology. 2008 ; Vol. 63, No. 3. pp. 355-365.
@article{8d5e3756b1164fab9672fb22e891048a,
title = "Saccadic palsy after cardiac surgery: Characteristics and pathogenesis",
abstract = "Objective: To characterize the syndrome of saccadic palsy that may follow cardiac surgery, and to interpret the findings using current concepts of the neurobiology of fast eye movements. Methods: Using the magnetic search coil technique, we measured eye, eyelid, and head movements of 10 patients who developed selective palsy of saccades after cardiac surgery. Results: Patients showed varying degrees of slowing and hypometria of saccades in the vertical plane or both horizontal and vertical planes, with complete loss of all saccades in one patient. Quick phases of nystagmus were also affected, but smooth pursuit, vergence, and the vestibuloocular reflex were usually spared. The smallest saccades were less slowed than larger saccades. Affected patients were visually disabled by loss of ability to voluntarily shift their direction of gaze. Blinks and head thrusts modestly improved the range and speed of voluntary movement. The syndrome usually followed aortic valve replacement. Common accompanying features included dysarthria, labile emotions, and unsteady gait. The saccadic palsy either improved during the early part of the course or remained static. Interpretation: Selective loss of all forms of saccades, with sparing of other eye movements, indicates malfunction of the brainstem machinery that generates saccades. A current model of brainstem circuits could account for both hypometria and slowing. This syndrome and the visual disability it causes often go unrecognized unless saccades are systematically tested at the bedside.",
author = "David Solomon and Stefano Ramat and Tomsak, {Robert L.} and Reich, {Stephen G.} and Shin, {Robert K.} and Zee, {David Samuel} and Leigh, {R. John}",
year = "2008",
month = "3",
doi = "10.1002/ana.21201",
language = "English (US)",
volume = "63",
pages = "355--365",
journal = "Annals of Neurology",
issn = "0364-5134",
publisher = "John Wiley and Sons Inc.",
number = "3",

}

TY - JOUR

T1 - Saccadic palsy after cardiac surgery

T2 - Characteristics and pathogenesis

AU - Solomon, David

AU - Ramat, Stefano

AU - Tomsak, Robert L.

AU - Reich, Stephen G.

AU - Shin, Robert K.

AU - Zee, David Samuel

AU - Leigh, R. John

PY - 2008/3

Y1 - 2008/3

N2 - Objective: To characterize the syndrome of saccadic palsy that may follow cardiac surgery, and to interpret the findings using current concepts of the neurobiology of fast eye movements. Methods: Using the magnetic search coil technique, we measured eye, eyelid, and head movements of 10 patients who developed selective palsy of saccades after cardiac surgery. Results: Patients showed varying degrees of slowing and hypometria of saccades in the vertical plane or both horizontal and vertical planes, with complete loss of all saccades in one patient. Quick phases of nystagmus were also affected, but smooth pursuit, vergence, and the vestibuloocular reflex were usually spared. The smallest saccades were less slowed than larger saccades. Affected patients were visually disabled by loss of ability to voluntarily shift their direction of gaze. Blinks and head thrusts modestly improved the range and speed of voluntary movement. The syndrome usually followed aortic valve replacement. Common accompanying features included dysarthria, labile emotions, and unsteady gait. The saccadic palsy either improved during the early part of the course or remained static. Interpretation: Selective loss of all forms of saccades, with sparing of other eye movements, indicates malfunction of the brainstem machinery that generates saccades. A current model of brainstem circuits could account for both hypometria and slowing. This syndrome and the visual disability it causes often go unrecognized unless saccades are systematically tested at the bedside.

AB - Objective: To characterize the syndrome of saccadic palsy that may follow cardiac surgery, and to interpret the findings using current concepts of the neurobiology of fast eye movements. Methods: Using the magnetic search coil technique, we measured eye, eyelid, and head movements of 10 patients who developed selective palsy of saccades after cardiac surgery. Results: Patients showed varying degrees of slowing and hypometria of saccades in the vertical plane or both horizontal and vertical planes, with complete loss of all saccades in one patient. Quick phases of nystagmus were also affected, but smooth pursuit, vergence, and the vestibuloocular reflex were usually spared. The smallest saccades were less slowed than larger saccades. Affected patients were visually disabled by loss of ability to voluntarily shift their direction of gaze. Blinks and head thrusts modestly improved the range and speed of voluntary movement. The syndrome usually followed aortic valve replacement. Common accompanying features included dysarthria, labile emotions, and unsteady gait. The saccadic palsy either improved during the early part of the course or remained static. Interpretation: Selective loss of all forms of saccades, with sparing of other eye movements, indicates malfunction of the brainstem machinery that generates saccades. A current model of brainstem circuits could account for both hypometria and slowing. This syndrome and the visual disability it causes often go unrecognized unless saccades are systematically tested at the bedside.

UR - http://www.scopus.com/inward/record.url?scp=41849134373&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=41849134373&partnerID=8YFLogxK

U2 - 10.1002/ana.21201

DO - 10.1002/ana.21201

M3 - Article

C2 - 17696176

AN - SCOPUS:41849134373

VL - 63

SP - 355

EP - 365

JO - Annals of Neurology

JF - Annals of Neurology

SN - 0364-5134

IS - 3

ER -