The brainstem contains ocular motor and vestibular structures that, when damaged, produce specific eye movement disorders. In this review, we will discuss three brainstem syndromes with characteristic ocular motor and vestibular findings that can be highly localizing. First, we will discuss the lateral medullary (Wallenberg) syndrome, focusing on ocular lateropulsion, saccadic dysmetria, and the ocular tilt reaction. Second, we will review the medial longitudinal fasciculus syndrome including the ocular tilt reaction, nystagmus, and the vestibular-ocular reflex. Lastly, we will discuss hypertrophic olivary degeneration and oculopalatal tremor, which may develop weeks to months after a brainstem or cerebellar lesion. In these syndromes, the clinical ocular motor and vestibular examination is instrumental in localizing the lesion.
Departments of *Neurology and
†Neurology, Ophthalmology, Neurosurgery, Otolaryngology—Head and Neck Surgery, Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Address correspondence and reprint requests to Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology—Head and Neck Surgery, Emergency Medicine, The Johns Hopkins University School of Medicine, 600 N Wolfe St, Pathology 2-210, Baltimore, MD 21287, U.S.A.; e-mail: Dgold7@jhmi.edu
The authors have no funding or conflicts of interest to disclose.