Internuclear ophthalmoplegia

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Classification according to ICD-10
H51.2 Internuclear ophthalmoplegia
ICD-10 online (WHO version 2019)

The internuclear ophthalmoplegia (INO) is one of the pränukleären paralysis of eye movements and therefore differs from a gaze palsy as a disturbance within the supranuclear centers . It occurs when the medial longitudinal fasciculus (MLF) in the midbrain is damaged , which coordinates the interaction of the various cranial nerve nuclei controlling the eye muscles ( oculomotor nerve , trochlear nerve , abducens nerve ). Since the medial longitudinal fasciculus is located near the midline, the INO often occurs on both sides. The INO primarily affects the internuclear neurons of the mutual abduction nucleus , which pull in the damaged medial longitudinal fasciculus to the equilateral (ipsilateral) nucleus of the oculomotor nerve , in order to cause adduction of the eye on the side of the damage with simultaneous abduction of the other (contralateral) eye to coordinate.

The correlating gaze disorder is a partial to complete inability to move the eye towards the nose on the side of the lesion when looking to the opposite side ( adduction weakness). The other eye performs a rapid pendulum movement during the corresponding gaze movement, called dissociated gaze direction nystagmus (see nystagmus ). In the convergence reaction, on the other hand, the paralyzed eye is able to adduct. This is so because the coordination of the convergence reaction is not controlled by the medial longitudinal fasciculus . With a double-sided INO, not only horizontal but also vertical movements are disturbed to a lesser extent (shortened gaze saccades).

The cause of isolated internuclear ophthalmoplegia can be multiple sclerosis , but also brain inflammation , tumors or small (lacunar) midbrain infarctions or cerebral hemorrhages .

The combination with a horizontal gaze palsy on the side of the INO is called the one and a half syndrome . It is a unilateral lesion in the area of ​​the PPRF, i. H. paramedian pontine reticular formation or Formatio reticularis pontis paramediana (= horizontal paresis) and in the area of ​​the ipsilateral Fasciculus longitudinalis medialis (= INO). One eye cannot move horizontally (except for convergence, see above), the other eye can still be abducted.

literature

  • Mathias Bähr, Michael Frotscher : Duus' neurological-topical diagnostics. Anatomy, function, clinic. With the collaboration of Wilhelm Küker. Founded by Peter Duus. 8th, completely revised edition. Thieme, Stuttgart 2003. ISBN 3-13-535808-9 .
  • Herbert Kaufmann (Ed.): Strabismus. With the collaboration of Wilfried de Decker et al. Enke, Stuttgart 1986, ISBN 3-432-95391-7 .
  • Klaus Poeck , Werner Hacke : Neurology. 10th, completely revised and largely rewritten edition. Springer, Berlin et al. 1998, ISBN 3-540-63028-7 .
  • Frank Thömke: Eye movement disorders. A clinical guide for neurologists. 2nd, updated and expanded edition. Thieme, Stuttgart et al. 2008, ISBN 978-3-13-128742-7 .