Ocular contrapulsion in multiple sclerosis: Clinical features and pathophysiological mechanisms

Elliot Frohman, T. C. Frohman, J. Fleckenstein, M. K. Racke, K. Hawker, P. D. Kramer

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

The objective was to describe in multiple sclerosis, a cerebellar eye movement syndrome that resulted from an acute episode of inflammatory demyelination. Contrapulsion is an ocular motor disturbance characterised by a triad of (1) hypermettic saccadic eye movements in a direction opposite from a precisely localised lesion within a specific white matter pathway, the uncinate fasciculus, at the level of the superior cerebellar peduncle (SCP); (2) hypometric saccades towards the side of the lesion; (3) oblique saccades directed away from the side of the lesion on attempted vertical saccades. Infrared oculography was used to demonstrate the characteristic features of contrapulsion in two patients with multiple sclerosis. Brain MRI showed lesions within the region of the uncinate fasciculus and superior cerebellar peduncle in both patients. Eye movement recordings showed saccadic hypermetria away from the side of the lesion and saccadic hypometria towards the side of the lesion. The hypometria decomposed into a series of stepwise movements as the eye approached the target. Oblique saccades directed away from the side of the lesion were seen on attempted vertical saccades. In conclusion, ocular contrapulsion can be seen in patients with multiple sclerosis and results from a lesion in the region of the SCP, involving the uncinate fasciculus.

Original languageEnglish (US)
Pages (from-to)688-692
Number of pages5
JournalJournal of Neurology Neurosurgery and Psychiatry
Volume70
Issue number5
DOIs
StatePublished - May 2001

Keywords

  • Contrapulsion
  • Ipsipulsion
  • Superior cerebellar peduncle
  • Uncinate fasciculus

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

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