Isolated Floccular Infarction with Impairment of High-Frequency Vestibulo-Ocular Reflex: A Case Report

The flocculus plays a crucial role in control of eye movements. Based on animal experiment, it is suggested that the flocculus is important for governing vestibuleocular reflexes. In humans, an isolated floccular lesion is extremely rare. We report oculomotor abnormalities in a patient with unilateral infarction of the flocculus, and compare our results with those of previously reported patients with floccular lesion.

Case Report: Neuropsychological Findings in IgLON5 Antibody Disorder

IgLON5 antibody encephalopathy is a rare but increasingly recognized disorder with a variety of clinical signs. Typical symptoms are sleep disorder, gait disturbances, signs of bulbar dysfunction and a variety of neurological symptoms like oculomotor abnormalities and movement disorders. In addition, cognitive decline can be a prominent symptom. So far, there are only a few studies that have dealt with the course and possible treatment options of IgLON5 antibody encephalopathy. In this study the clinical case of a female patient with IgLON5 antibody disease and the response to treatment is described. Here we report on the case of a 67-year-old female patient who showed cognitive deterioration, gait difficulties, and chronic obstructive sleep disorder. The diagnostic course showed a positive anti-IgLON5 serum and anti-IgLON5 IgG antibodies in cerebrospinal fluid. The patient was subsequently treated with high dosage i.v. methylprednisolone, i.v. immunoglobulins and plasmapheresis. Neuropsychological tests showed cognitive deficits in different domains, including verbal and visual memory. Both, neuropsychological deficits and antibody titer, showed an improvement after plasmapheresis. The presented case shows that IgLON5 disease can present with rapidly progressing cognitive deterioration as the prominent symptom, adding to the variety of clinical signs in this disorder. Testing for IgLON5-antibodies should be considered in patients with progressing cognitive decline, especially if accompanied by sleep disorders or neurological symptoms like oculomotor abnormalities, dysautonomia or bulbar signs.

Visual Deficiency in Wallenberg’s Syndrome

The aim of this case report of a 47-year-old woman who suffered from acute right-sided medullar ischemic stroke was to define the range of visual impairment in Wallenberg’s syndrome (WS). The patient complained of unbearable environmental tilt and rotating visual perception. On examination, 11 months following the stroke, the patient manifested rightsided postural inclination and gaze ipsipulsion. The fixation in primary position was unstable, after a conjugate ipsipulsion ensued, spontaneous corrective saccades and a horizontal-rotational jerking nystagmus beating away from the side of the lesion were generated. Monocular visual acuity (right eye: 0.4 logMAR distance and 0.2 logMAR near; left eye: 0.1 logMAR distance and 0.0 logMAR near) was significantly better than binocular (0.63 logMAR distance and near). Fluent reading was impossible. Contralateral smooth pursuits were more impaired. Saccades were defective manifesting right hypermetria and left hypometria. Visual field was constricted to central 10 – 20°. A diagnosis of Wallenberg’s syndrome was made. Occlusion was prescribed. Review of literature demonstrated lack of evidence-based guidelines for ophthalmic assessment and treatment of visual impairment in WS. Oculomotor abnormalities, oscillopsia and tilt illusion cause significant impact to daily life. Early post-stroke ophthalmological evaluation is thus mandatory in order to offer timing treatment.

Vestibular and oculomotor abnormalities among HIV-infected and HIV-uninfected men and women: A pilot study

OBJECTIVE: To determine if middle-aged and aging men and women with HIV disease (HIV+) should be screened for vestibular and oculomotor dysfunction. METHODS: Age- and sociodemographically matched HIV+ and HIV– men and women were tested on vestibular evoked myogenic potential (VEMP), bi-thermic caloric testing, Dix-Hallpike maneuvers and saccades. RESULTS: HIV+ men had more caloric weakness than HIV– men. HIV+ subjects had more saccade abnormalities than HIV– subjects. A saccade abnormality was positively associated with being HIV+. Among the HIV+ sample, abnormalities were associated with increasing age, being male, ever taking monotherapy, and having an undetectable viral load. Only being male and having an undetectable viral load were statistically significant. Unilateral caloric weakness had a decreased prevalence with age per 10 years, and being HIV+ showed an increased prevalence. In HIV+ subjects only, these abnormalities decreased with age and being male but increased with undetectable viral load and ever taking antiretroviral monotherapy. No statistically significant differences were found. CONCLUSION: Women are at greater risk of vestibular and oculomotor abnormalities than men. HIV+ adults are at greater risk than HIV– adults. Physicians who care for HIV+ men and women should monitor the symptoms of vestibular and oculomotor impairment.

Clinical Characterization of Oculomotricity in Children with and without Specific Learning Disorders

Children with specific learning disorders have been associated with oculomotor problems, with their analysis even suggested to be a potential diagnostic tool. A prospective non-randomized comparative study evaluating 59 children (6–13 years old) divided into three groups was conducted: a control group (CG) including 15 healthy emmetropic children; a group of 18 healthy children with oculomotor abnormalities (OAG); and a group of 26 children diagnosed with specific learning disorders (LDG). In all groups, besides a complete eye exam, oculomotricity was characterized with two clinical tests: Northeastern State University College of Optometry’s Oculomotor (NSUCO) and Developmental Eye Movement (DEM) tests. Concerning the NSUCO test, lower ability, precision, and head/body movement associated scorings were obtained for both smooth pursuits and saccades in OAG and LDG when compared to the CG (p < 0.001). Likewise, significantly longer time needed to read the horizontal sheet of the DEM test and a higher DEM ratio were found in OAG and LDG compared to CG (p ≤ 0.003). No differences between LDG and OAG were found in the performance with the two oculomotor tests (p ≥ 0.141). Oculomotor anomalies can be present in children with and without specific learning disorders, and therefore cannot be used as diagnostic criteria of these type of disorders.

Pursuit eye movements in dyslexic children: evidence for an immaturity of brain oculomotor structures?

Background: Dyslexia is a disorder found in 5–10% of school-aged children. Several studies reported visual deficits and oculomotor abnormalities in dyslexic children. The objective of our study was to examine horizontal pursuit performance in dyslexic children, despite its poor involvement in reading. Methods: Eye movements were recorded by video-oculography in 92 children (46 dyslexic children, mean age: 9.77 ± 0.26 and 46 non dyslexic, IQ- and age-matched children). Both the number of catch-up saccades occurring during pursuit task and the gain of pursuit were measured. Results: Catch-up saccades were significantly more frequent in the dyslexic group than in the non-dyslexic group of children. Pursuit performance (in terms of the number of catch-up saccades and gain) significantly improved with increasing age in the non-dyslexic children group only. Conclusions: The atypical pursuit patterns observed in dyslexic children suggest a deficiency in the visual attentional processing and an immaturity of brain structures responsible for pursuit triggering. This finding needs to be validated by neuroimaging studies on dyslexia population.

Vestibular Screening in Pediatric Patients with Otitis Media

Otitis media with effusion (OME) is a common cause of vestibular disturbances in children. However, young children often lack the language to express their symptoms, and it is uncommon to screen children for vestibular impairments.The purpose of this study was to develop a screening protocol for children presenting with OME to determine if diagnostic vestibular testing is necessary.Children with normal hearing (NH), sensorineural hearing loss (SNHL), and conductive hearing loss (CHL) due to OME participated in a vestibular screening.There were 30 participants, ages four to eight years, ranging from 48 to 101 months included in the study: 10 with NH, 11 with CHL due to OME, and 9 with SNHL.The vestibular screening consists of patient and parent questionnaires and a functional evaluation. The tests examined coordination, balance, oculomotor function, and nystagmus.Those with CHL were significantly more likely to display abnormal smoothness of pursuit, as measured with observations for rapid tracking, absence of or delayed saccades, and overshoot, than those with NH or SNHL (p = 0.012). Parents of children with CHL due to OME were more likely to report their child experiencing middle ear pressure than the parents of children with NH or SNHL (p = 0.010). In addition, children with CHL were less likely to report hearing loss than those with NH or SNHL. Parent and patient report were not found to be reliable indicators of vestibular disturbances.This pilot study suggests that children with CHL due to OME present with more oculomotor abnormalities than their peers with NH. Further research is necessary to determine validity and reliability of the findings for this present study.

Cognitive Impairment and Diminished Neural Responses Constitute a Biomarker Signature of Negative Symptoms in Psychosis

The treatment of negative symptoms (NS) in psychosis represents an urgent unmet medical need given the significant functional impairment it contributes to psychosis syndromes. The lack of progress in treating NS is impacted by the lack of known pathophysiology or associated quantitative biomarkers, which could provide tools for research. This current analysis investigated potential associations between NS and an extensive battery of behavioral and brain-based biomarkers in 932 psychosis probands from the B-SNIP database. The current analyses examined associations between PANSS-defined NS and (1) cognition, (2) pro-/anti-saccades, (3) evoked and resting-state electroencephalography (EEG), (4) resting-state fMRI, and (5) tractography. Canonical correlation analyses yielded symptom-biomarker constructs separately for each biomarker modality. Biomarker modalities were integrated using canonical discriminant analysis to summarize the symptom-biomarker relationships into a “biomarker signature” for NS. Finally, distinct biomarker profiles for 2 NS domains (“diminished expression” vs “avolition/apathy”) were computed using step-wise linear regression. NS were associated with cognitive impairment, diminished EEG response amplitudes, deviant resting-state activity, and oculomotor abnormalities. While a connection between NS and poor cognition has been established, association to neurophysiology is novel, suggesting directions for future mechanistic studies. Each biomarker modality was related to NS in distinct and complex ways, giving NS a rich, interconnected fingerprint and suggesting that any one biomarker modality may not adequately capture the full spectrum of symptomology.