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Ocular Motor Dysfunction Due to Brainstem Disorders

Lee, Seung-Han, MD, PhD; Kim, Hyo-Jung, PhD; Kim, Ji-Soo, MD, PhD

Section Editor(s): Biousse, Valerie MD; Galetta, Steven MD

doi: 10.1097/WNO.0000000000000583
State-of-the-Art Review

Background: The brainstem contains numerous structures including afferent and efferent fibers that are involved in generation and control of eye movements.

Evidence Acquisition: These structures give rise to distinct patterns of abnormal eye movements when damaged. Defining these ocular motor abnormalities allows a topographic diagnosis of a lesion within the brainstem.

Results: Although diverse patterns of impaired eye movements may be observed in lesions of the brainstem, medullary lesions primarily cause various patterns of nystagmus and impaired vestibular eye movements without obvious ophthalmoplegia. By contrast, pontine ophthalmoplegia is characterized by abnormal eye movements in the horizontal plane, while midbrain lesions typically show vertical ophthalmoplegia in addition to pupillary and eyelid abnormalities.

Conclusions: Recognition of the patterns and characteristics of abnormal eye movements observed in brainstem lesions is important in understanding the roles of each neural structure and circuit in ocular motor control as well as in localizing the offending lesion.

Department of Neurology (S-HL), Chonnam National University Medical School, Gwangju, Korea; Research Administration Team (H-JK), Seoul National University Bundang Hospital, Seoul, Korea; and Department of Neurology (H-JK, J-SK), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea.

Address correspondence to Ji-Soo Kim, MD, PhD, Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea; E-mail:

The authors report no conflicts of interest.

© 2018 by North American Neuro-Ophthalmology Society