Hertwig-Magendie Syndrome

from Wikipedia, the free encyclopedia

As a skew deviation , Hertwig stomach diesche squint or skew deviation ( Engl. Skew "wrong," deviation "deviation") is a vertical squint of the eyes called, in one eye, the other is lower raise. It is named after the German veterinarian Carl Heinrich Hertwig and the French physiologist François Magendie .

Usually there is also bilateral curling in the same direction ( cycloversion ), with the lower eye rotated outwards and the higher one rotated inwards. Alternating shapes can also occur, in which the right eye and the left eye are positioned over the other. The deviation of the two eyes in the vertical plane can be the same ( concomitant ), but also unequal ( incomitant ) in all viewing directions . In this respect, it is not a question of paralysis squint . Occur diplopia , which vertically offset and - can also be tilted - depending on the extent of the roll sensors (cyclodeviation) of the eyes. In addition, the patient's subjective verticals tilt and the head tilts . The entire symptom complex is also known as the Ocular Tilt Reaction .

The cause is a prenuclear (above the eye muscle nerve nuclei ) lesion in the brain stem between the mid- and cerebellum , in the area of ​​the peripheral vestibular apparatus or the bridge . The possible different localizations probably cause an interruption of the pathways from the otolith apparatus to the core area of ​​the oculomotor nerve and the trochlear nerve and therefore lead to a vertical squint. The combination with additional disorders of eye movements or other neurological functions is typical.

Differential diagnosis

Hertwig-Magendie syndrome must be distinguished from the concomitant vertical disorders of strabismus sursoadductorius and strabismus deorsoadductorius , as well as from the clinical picture of dissociated vertebral squint .

Individual evidence

  1. ↑ H. Hertwig: Experilmenta quaedam de effectibus laesionum in partibus encephali singularibus et de verosimili harum partium functione. In: Ind Cat Surg-Gen. 1885; P. 185.

literature

  • Herbert Kaufmann (Ed.): Strabismus. With the collaboration of W. de Decker et al., 3rd edition, Georg Thieme Verlag, 2003, ISBN 3-13-129723-9 , p. 471 ff.
  • A. Hufschmidt, CH Lücking, S. Rauer (Ed.): Neurology compact . Thieme, Stuttgart 2009, ISBN 978-3-13-117195-5 .
  • AM Wong: Understanding skew deviation and a new clinical test to differentiate it from trochlear nerve palsy. In: J AAPOS. 2010 Feb; 14 (1), pp. 61-67, doi: 10.1016 / j.jaapos.2009.11.019 . PMID 20227626 .