The document describes various types of saccadic eye movements and their neurological localization. It discusses normal saccades as well as abnormal saccadic patterns including square-wave jerks, ocular flutter, macro-saccades, saccadic pulses, opsoclonus, and others. It also covers saccade velocity and accuracy abnormalities and how they may indicate lesions in structures like the basal ganglia, brainstem, cerebellum, and cranial nerves. Analysis of saccade latency, duration, amplitude, velocity, and gain is discussed to evaluate test results.
The document describes various types of saccadic eye movements and their neurological localization. It discusses normal saccades as well as abnormal saccadic patterns including square-wave jerks, ocular flutter, macro-saccades, saccadic pulses, opsoclonus, and others. It also covers saccade velocity and accuracy abnormalities and how they may indicate lesions in structures like the basal ganglia, brainstem, cerebellum, and cranial nerves. Analysis of saccade latency, duration, amplitude, velocity, and gain is discussed to evaluate test results.
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The document describes various types of saccadic eye movements and their neurological localization. It discusses normal saccades as well as abnormal saccadic patterns including square-wave jerks, ocular flutter, macro-saccades, saccadic pulses, opsoclonus, and others. It also covers saccade velocity and accuracy abnormalities and how they may indicate lesions in structures like the basal ganglia, brainstem, cerebellum, and cranial nerves. Analysis of saccade latency, duration, amplitude, velocity, and gain is discussed to evaluate test results.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online from Scribd
fixation • Large saccades may be faster than 500º/sec and last < 100 ms • The cerebellum calibrates for the best visuo-ocular motor behavior – saccadic amplitude in the dorsal vermis and fastigial nucleus – Saccadic pulse step match in the flocculus • Cerebellum also influences the latency of saccades Saccades • Square-Wave Jerks – Pairs of small horizontal saccades pulling the eye off target and then back • with in 200 – 400 ms • Typically .5º (range 0.1 - 4.0) • Typically occur in a series – More common in older population – Found in certain cerebellar syndromes • PSP (progressive supernuclear palsy) – Are very frequent – Increase in frequency in cigarette smoking – Increase in dementia patients due to distractibility Saccades • Ocular Flutter – Intermittent conjugate bursts of saccades – Have no inter-saccadic interval – May be micro-flutter • So tiny only visible if zoom • (or look at with ophthalmoscope) – Causes: • Parainfections encephalitis • Paraneoplastic syndromes • Meningitis • Intracranial tumors • Hydrocephalus • MS • Systemic disease Saccades • Causes Continued (Ocular Flutter) – Drug side effects: lithium, imitriptyline, cocaine, phenytoin w/ diazepam, phenelzine w/ imipramine – Toxins: chlordecone, thallium, strychnine, toluene, organophosphates – Complication of pregnancy – Transient normal phenomenon in infants – And in conditions we would not be testing » Thalamic Hemorrhage » Hypersmolar coma Saccades • Macro-Saccades (Macrosquare-wave Jerks, or Macrosaccadic Pulses) – Large Saccades that pull the eye off target and return it within 70-150 ms – Usually 5-15º and vary in amplitude – Occur in light or dark – Usually suppressed by monocular fixation – MS and multiple system atrophy Saccades • Macro-Saccadic Oscillations – Hypermetric saccades (oscillations) that come and go with an inter-saccadic interval of 200 ms – Happen when fixating on a point – Occur most often with lesions of fastigial nucleus and its output in the cerebellar peduncles • some forms of spinocerebellar ataxia • Occasionally with pontine lesions (if compromise the Saccades • Saccadic Pulses – Brief small saccade away from the target followed by a rapid drift back (glissade) • Due to lack of saccadic step • INO • Opsoclonus – Multidirectional (horizontal, vertical and torsional) saccadic oscillations – Has no intersaccadic interval – Causes are similar to Ocular Flutter • Voluntary Nystagmus – High frequency (15-25º/sec) – Conjugate horizontal oscillations – <30 seconds sustained – Usually brought about by fixation Opsoclonus Opsoclonus Saccades • Random Saccades: – Individual eye movement recordings made – Calibrate each separately (when recording each) – Done on computerized systems – Position of target randomized from 0-30 degrees to the right or left of center – Timing randomized – Gives reactionary saccades • Analysis – Accuracy – Latency – Velocity Saccades Shepard & Telian 1996 Saccades • Saccade Velocity Abnormalities – Overall slowing in both directions (conjugate or individual eye recordings) • Medications/ drowsiness/ fatigue • Basal ganglia when latency is increased with accuracy undershoot abnormality • Brainstem (PPRF) when latency increased • Cerebellar – Ex. Olivopontocerebellar atrophy • Bilateral internuclear opthalmoplegia Slow Saccades Saccadic Slowing Saccades • Saccade Velocity Abnormalities – Abnormally fast • Calibration error • Restriction syndromes – (mechanical condition limiting range of motion of eye but not velocity) – Asymmetrical Velocity • Restriction syndromes • Internuclear Opthalmoplegia Saccade Velocity Abnormalities • Localization Summary: – Lesion of: • Basal ganglia • Brainstem • Cerebellum • Peripheral oculomotor nerves or muscles – Rule out: • Inattention • Fatigue • Medications Saccades • Internuclear Opthalmoplegia – Caused by a lesion to the MLF – Affects both horizontal and vertical eye movements – Cardinal sign • Paresis of adduction by the eye on the side of the MLF lesion during conjugate eye movement • Look for saccadic slowing of adducting movement… adduction lag – Nystagmus on abduction of the eye contralateral to the lesion Saccades • INO – Differential degrees cause… • Paralysis of adduction or paresis only apparent as slowing of adducting saccades • Disconjugacy of quick phase with slowing of adducting eye – Very positive for INO • Convergence may be preserved or impaired • Skew deviation may be present • Dissociated vertical nystagmus – Downbeat in ipsi eye and torsional in contra eye may be present Saccades • INO Etiology – Unilateral INO • Most commonly related to ischemia – Bilateral INO • Most commonly due to demyelination associated with MS – Other causes • Brainstem and 4th ventricular tumors and mesencephalic clefts • Arnold-Chiari malformation and associated hydrocephalus and syringobulbia • Infection: meningoencephalitis – Viral, bacterial, AIDS Saccades • INO – Other causes continued • Hydrocephalus, subdural hematoma, supratentorial arteriovenous malformation • Nutritional disorders • Metabolic disorders • Drug intoxications • Cancer • Head trauma • Degenerative conditions • Syphilis • Pseudo-INO of Myasthenia gravis INO
Bilateral INO Unilateral INO
INO INO Saccade Accuracy • Overshoot Dysmetria (lack of coordination of movement) (Hypermetric saccades) – CPA pathological process • Ipsilateral eye movements – Cerebellar (fastigial nuclei) • Bilateral eye movements – INO (ipsi to MLF lesion) – Visual field deficits • Undershoot Dysmetria (Hypometric saccades) – Cerebellar (dorsal vermis) • Bilateral eye movements – Basal ganglia • When velocity is slowed and latency is increased Saccades- Hypometric Saccades - Hypermetric Saccade Accuracy • Glissades (eye velocity slows just prior to reaching the target and the eye gradually acquires the target or steps with a small additional saccade) – Cerebellar • Unilateral or bilateral – Muscle or nerve weakness – Rule out head movement during test Saccade Accuracy • Ocular-lateral pulsion – Saccades that are too large in one direction and too small in the other direction • Posterior Inferior Cerebellar Artery (PICA) distribution involvement (ipsilateral-medullary syndrome) – Ipsipulsion: overshoots toward the side of the lesion and undershoots away from the side of the lesion Ocular-lateral pulsion continued • Infarcts in the distribution of the superior cerebellar artery – Contrapulsion: overshoots away from side of lesion and undershoots toward the side of lesion – Most labs do not attempt to record this Lateropulsion Saccade Latency • Overall increased latency – Inattention/ medication / drowsiness – Basal ganglia when velocity is slowed and ocular dysmetria with undershoots present – Brainstem (PPRF) when velocity reduced – Seen in Parkinson’s disease for volitional saccade tasks not reactionary • Asymmetrical latency – Parietal or occipital lobe involvement • Ex. CVA Saccade Latency - Overall Increased Other Saccade Abnormalities • Antisaccade abnormality – Frontoparietal cortex • Remembered saccade abnormality – Dominantly frontal (secondary parietal) cortex Analysis - Saccades Analysis - Saccades • Saccade V Limits – Adjust lower and upper saccade velocity threshold limits. The data segments that are excluded will be highlighted in red. • Min Delay – minimum time delay after stimuli motion occurrence that a patient response (saccade) can be classified as valid (default: 0.08 sec) • Max Delay – maximum time delay after stimuli motion occurrence that a patient response (saccade) can be classified as valid (default: 0.6 sec) • Min Duration – minimum step duration to be classified as a valid saccade (default: 0.04 sec) • Min Peak Saccade V – minimum peak velocity to be a classified as a valid saccade (default: 60º/sec) Analysis - Saccades • Saccade Results: – Latency • time between target stimuli motion and the beginning of the saccade (sec) – Duration • time that the saccade velocity remains greater than the minimum velocity (sec) – Amplitude • difference between eye position at the beginning and the end of the saccade (deg) – Max velocity • maximum saccade eye velocity (deg/sec) – Gain • ratio between eye position and laser dot position for each saccade (%) Saccade, norms