Ординатура / Офтальмология / Английские материалы / The Neurology of Eye Movements_Leigh, Zee_2006
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THE NEUROLOGYOF EYE MOVEMENTS
THIRD EDITION
CONTEMPORARY NEUROLOGY SERIES AVAILABLE:
19THE DIAGNOSIS OF STUPOR AND COMA, EDITION 3 Fred Plum, M.D., and Jerome B. Posner, M.D.
26PRINCIPLES OF BEHAVIORAL NEUROLOGY M-Marsel Mesulam, M.D., Editor
32CLINICAL NEUROPHYSIOLOGY OF THE VESTIBULAR SYSTEM, EDITION 2 Robert W. Baloh, M.D., and Vincente Honrubia, M.D.
36DISORDERS OF PERIPHERAL NERVES, EDITION 2
Herbert H. Schaumburg, M.D., Alan R. Berger, M.D., and P.K. Thomas, C.B.E., M.D., D.Sc., F.R.C.R, F.R.C.Path.
38PRINCIPLES OF GERIATRIC NEUROLOGY
Robert Katzman, M.D., and John W. Rowe, M.D., Editors
42MIGRAINE: MANIFESTATIONS, PATHOGENESIS, AND MANAGEMENT Robert A. Davidoff, M.D.
43NEUROLOGY OF CRITICAL ILLNESS Eelco F. M. Wijdicks, M.D., Ph.D., F.A.C.P.
44EVALUATION AND TREATMENT OF MYOPATHIES
Robert C. Griggs, M.D., Jerry R. Mendell, M.D., and Robert G. Miller, M.D.
45 NEUROLOGIC COMPLICATIONS OF CANCER
Jerome B. Posner, M.D.
46CLINICAL NEUROPHYSIOLOGY Jasper R. Daube, M.D., Editor
47NEUROLOGIC REHABILITATION Bruce H. Dobkin, M.D.
48PAIN MANAGEMENT: THEORY AND PRACTICE
Russell K. Portenoy, M.D., and Ronald M. Kanner, M.D., Editors
49AMYOTROPHIC LATERAL SCLEROSIS
Hiroshi Mitsumoto, M.D., D.Sc., David A. Chad, M.D., F.R.C.P., and Eric P. Pioro, M.D., D.Phil., F.R.C.P.
50MULTIPLE SCLEROSIS
Donald W. Paty, M.D., F.R.C.P.C., and George C. Ebers, M.D., F.R.C.P.C.
51NEUROLOGY AND THE LAW: PRIVATE LITIGATION AND PUBLIC POLICY H. Richard Beresford, M.D., J.D.
52SUBARACHNOID HEMORRHAGE: CAUSES AND CURES Bryce Weir, M.D.
53SLEEP MEDICINE Michael S. Aldrich, M.D.
54BRAIN TUMORS
Harry S. Greenberg, M.D., William F. Chandler, M.D., and Howard M. Sandier, M.D.
55THE NEUROLOGY OF EYE MOVEMENTS, EDITION 3 R.John Leigh, M.D., and David S. Zee, M.D.
(book and CD-ROM versions available)
THE NEUROLOGYOF EYE MOVEMENTS
THIRD EDITION
R. John Leigh
Professor, Departments of Neurology, Neurosciences,
Otolaryngology, and Biomedical Engineering
Case Western Reserve University
University Hospitals and Department of
Veterans Affairs Medical Center
Cleveland, Ohio
David S. Zee
Professor of Neurology, Ophthalmology,
Otolaryngology and Head and
Neck Surgery, and Neuroscience
Director, Ocular Motor-Visual Testing Lab
Johns Hopkins University
Baltimore, Maryland
New York Oxford
OXFORD UNIVERSITY PRESS
1999
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Copyright © 1999 by Oxford University Press Inc.
Published by Oxford University Press Inc.,
198 Madison Avenue, New York, New York 10016
Oxford is a registered trademark of Oxford UniversityPress.
All right reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Oxford University Press.
Library of Congress Cataloging-in-Publication Data Leigh, R.John.
The neurology of eye movements / R.John Leigh, David S. Zee. — 3rd ed.
p. cm. — (Contemporary neurology series ; 55) Includes bibliographical references and index.
ISBN 0-19-512972-5.— ISBN 0-19-512973-3 (book/CD package). — ISBN 0-19-512974-1 (CD ROM upgrade)
1.Eye—Movement disorders—Diagnosis. 2. Eye—Movements. 3. Diagnosis, Differential. I. Zee, David S. II. Title. III. Series.
[DNLM: 1. Eye Movements—physiology. 2. Ocular Motility Disorders. WlC'769Nv.55 1999] RE731.L44 1999 617.7'62—dc21 DNLM/DLC for Library of Congress 98-37880
The science of medicine is a rapidly changing field. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy do occur. The author and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is accurate and complete, and in accordance with the standards accepted at the time of publication. However, in light of the possibilityof human error or changes in the practice of medicine, neither the author, nor the publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete. Readers are encouraged to confirm the information contained herein with other reliable sources, and are strongly advised to check the product information sheet provided by the pharmaceutical company for each drug they plan to administer.
9 8 7 6 5 4 3 2 1
Printed in the United States of America on acid-free paper.
PREFACE TO
THE THIRD EDITION
As in the first two editions of The Neurology of Eye Movements, our main goal has been to synthesize information discovered through basic research into a form that is directly applicable to the interpretation of clinical disorders of eye movements.
A number of new concepts appear in this edition, such as three-dimensional aspects of eye rotations, identification of cortical "eye fields" in humans by functional imaging, and the development of treatments for nystagmus and other abnormal movements that impair vision. New findings have required us to revise or modify our hypothetical schemes for several classes of eye movements. In making these substantial revisions, we have abided with our effort to write for a broad audience that includes neurologists, ophthalmologists, otolaryngologists, optometrists, neurosurgeons, psychiatrists, and basic researchers working in various aspects of neuroscience for whom eye movements are pertinent. We have endeavored to provide up-to-date references but, since the current output of scientific papers is large, have had to leave out some fine citations that appeared in previous editions. The growth of the scientific and clinical literature shows no signs of slowing down. Thus, the reader will inevitably turn to bibliographic resources on the World Wide Web for the latest information. Nonetheless, we hope that the schemes we present here will provide a coherent way of interpreting basic and clinical research for some years.
New to this edition, we have provided the option of accessing supplementary material on a CD-ROM, in conjunction with the conventional clothbound book. Though the book can stand alone, the armchair reader can also choose to move to the computer to read and print the text, to view color figures and more than 60 videos referred to in the text, and to take advantage of the linking of physiology and anatomy with clinical ocular motor syndromes and their differential diagnosis.
The new CD-ROM component has many advantages. First, the reader can appreciate the dynamic characteristics of abnormal eye movements being discussed in the text, and relate these features to patients that they examine at the bedside. Second, when reading about a clinical disorder, access to pertinent basic information can be readily accessed (or vice versa) via hypertext links. This is facilitated by "displays," which summarize clinical syndromes and pertinent anatomy, and serve as bridges between related basic and clinical sections and videos. Case histories of illustrative patients, MR and CT scans, eye movement records, and videos are also linked in this way. One trade-off has been the need for us to make each heading and sub-heading specific, and the reader is asked to bear with what might seem unnecessary repetition of the topic titles within sections. Each video clip is quite short, to contain file size and facilitate real-time video images. The reader might find it useful to play the clips continuously while the legend is being read.
V
VI Preface
As is previous editions, we are indebted to many inidividuals who have contributed their expertise and time to improve our book, any short-comings being our own. The following individuals read substantial portions of the manuscript: Lea Averbuch-Heller, Kanokwan Boonyapisit, Stephan Brandt, Vallabh Das, Henry Kaminski, Phillip Kramer, Lloyd Minor, Lance Optican, Vivek Patel, Grace Peng, Klaus Rottach, Mark Shelhamer, Heimo Steffen, John Stahl, Ronald Tusa, and Mark Walker. Individuals who have provided reviews, figures, videos, or other contributions include Jean Biittner-Ennever, Patrick Chinnery, Mark Cohen, Robert Daroff, Louis Dell'Osso, Joseph Demer, Susan Herdman, Manabu Honda, Anja Horn, Henry Kaminski, Gregory Kosmorsky, Richard Leigh, Hans Liiders, Vendetta Matthews, Lloyd Minor, Joel Miller, Neil Miller, Adonis Moschovakis, Gary Paige, Robert Ruff, Scott Seidman, Robert Spencer, Ki Bum Sung, David Waitzman, Shirley Wray, Stacy Yaniglos, and Arthur Zinn. We are grateful to Bernice Wissler and Nancy Wolitzer for editorial assistance, and to Kyle Bates and Kirk Pedrick for help in making the videos. We thank Lauren Enck and her staff at Oxford University Press, Al Cecchini and his colleagues at Libera, and Sid Gilman for his crucial role in facilitating the publication of this edition. We are grateful for the continued support of our work by the National Eye Institute, the National Institute of Deafness and Communicative Disorders, the National Space Biomedical Research Institute (NASA), the Department of Veterans Affairs Medical Research Service, and the Evenor Armington Fund. Finally, we thank Daniele Nuti for making it possible for us to make a start on our writing in the inspiring atmosphere of the Certosa of the University of Siena, Italy.
January 1999 |
R.J.L. |
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D.S.Z. |
CONTENTS
PART I THE PROPERTIES AND NEURAL SUBSTRATE OF
EYE MOVEMENTS |
|
1. A SURVEY OF EYE MOVEMENTS: |
3 |
CHARACTERISTICS AND TELEOLOGY |
|
Why Study Eye Movements? |
3 |
Visual Requirements of Eye Movements |
5 |
Functional Classes of Eye Movements |
5 |
Orbital Mechanics: Phasic and Tonic Innervation |
6 |
Vestibular and Optokinetic Systems |
8 |
Saccadic System |
10 |
Smooth Pursuit and Visual Fixation |
10 |
Combined Movements of the Eyes and Head |
11 |
Vergence Eye Movements |
12 |
Three-Dimensional Aspects of Eye Movements |
12 |
Adaptive Control of Eye Movements |
13 |
Voluntary Control of Eye Movements |
13 |
Eye Movements and Spatial Localization |
14 |
The Scientific Method Applied to the Study of |
15 |
Eye Movements |
|
Summary |
15 |
2. THE VESTIBULAR-OPTOKINETIC SYSTEM |
19 |
Function of the Vestibular-Optokinetic System |
21 |
Anatomy and Physiology of the Peripheral Vestibular System |
24 |
Brain Stem Elaboration of the Vestibulo-ocular Reflex |
29 |
Neural Substrate for Optokinetic Responses |
36 |
Quantitative Aspects of the Vestibular-Optokinetic System |
37 |
Adaptive Properties of the Vestibulo-ocular Reflex |
48 |
Vestibulocerebellar Influences on the Vestibulo-ocular Reflex |
53 |
Vestibular Sensation |
56 |
Clinical Examination of Vestibular and Optokinetic Function |
57 |
Laboratory Evaluation of Vestibular and Optokinetic Function |
63 |
Pathophysiology of Disorders of the Vestibular System |
67 |
Summary |
72 |
3. THE SACCADIC SYSTEM |
90 |
The Purpose of Saccades |
90 |
Behavior of the Saccadic System |
91 |
Vii
Viii Contents |
|
Neurophysiology of Saccadic Eye Movements |
102 |
Saccades and Movements of the Eyelids |
126 |
Examination of Saccades |
128 |
Pathophysiology of Saccadic Abnormalities |
130 |
Summary |
134 |
4. SMOOTH PURSUIT AND VISUAL FIXATION |
151 |
The Purpose of Smooth Pursuit |
151 |
Visual Fixation |
152 |
Stimulus for Smooth Pursuit |
156 |
Quantitative Aspects of Smooth Pursuit |
159 |
Neural Substrate for Smooth Pursuit |
164 |
Models of Smooth Pursuit |
174 |
Clinical Examination of Fixation and Smooth Pursuit |
177 |
Laboratory Evaluation of Fixation and Smooth Pursuit |
179 |
Abnormalities of Visual Fixation and Smooth Pursuit |
180 |
Summary |
186 |
5. GAZE HOLDING AND THE NEURAL INTEGRATOR |
198 |
Neural Coding of the Ocular Motor Signal |
199 |
Quantitative Aspects of Neural Integration |
201 |
Neural Substrate for Gaze Holding |
203 |
Clinical Evaluation of Gaze Holding |
208 |
Abnormalities of the Neural Integrator |
209 |
Summary |
211 |
6. SYNTHESISOF THE COMMAND FOR CONJUGATE |
215 |
EYE MOVEMENTS |
|
Brain Stem Connections for Horizontal Conjugate |
215 |
Movements |
|
Brain Stem Connections for Vertical and Torsional |
221 |
Movements |
|
Cerebellar Influences on Gaze |
228 |
The Cerebral Hemispheres and Voluntary Control of |
233 |
Eye Movements |
|
Summary |
250 |
7. EYE-HEAD MOVEMENTS |
263 |
Stabilization of the Head |
263 |
Voluntary Control of Eye-Head Movements |
265 |
Examination of Eye-Head Movements |
273 |
Laboratory Evaluation of Eye-Head Movements |
273 |
Disorders of Eye-Head Movement |
274 |
Summary |
278 |
|
Contents |
iX |
8. VERGENCE EYE MOVEMENTS |
286 |
|
Stimuli to Vergence Movements |
|
287 |
Fusion or Disparity-Induced Vergence |
|
287 |
Blur-Induced Vergence |
|
290 |
The Near Triad |
|
290 |
Interactions between Accommodation and Vergence |
|
291 |
Dynamic Properties of Vergence Eye Movements |
|
292 |
Neural Substrate of Vergence Movements |
|
295 |
Conceptual Models of Supranuclear Control of Vergence |
|
300 |
Adaptive Mechanisms to Maintain Ocular Alignment |
|
302 |
Examination of Vergence Movements |
|
306 |
Abnormalities of Vergence |
|
307 |
Summary |
|
310 |
PART II: THE DIAGNOSIS OF DISORDERS OF EYE MOVEMENTS
9. DIAGNOSIS OF PERIPHERAL OCULAR MOTOR |
321 |
PALSIES AND STRABISMUS |
|
Anatomy of the Orbital Fascia and the Extraocular Muscles |
323 |
Structure and Function of Extraocular Muscle |
327 |
Anatomy of Ocular Motor Nerves and Their Nuclei |
331 |
Physiologic Basis for Conjugate Movements: |
336 |
Yoke Muscle Pairs |
|
Clinical Testing in Diplopia |
337 |
Pathophysiology of Some Commonly Encountered Signs |
344 |
in Strabismus |
|
Clinical Features and Diagnosis of Concomitant Strabismus |
348 |
Clinical Features of Ocular Nerve Palsies |
350 |
Disorders of the Neuromuscular Junction |
373 |
Chronic Progressive External Ophthalmoplegia and |
379 |
Restrictive Ophthalmopathies |
|
10. DIAGNOSIS OF CENTRAL DISORDERS OF |
405 |
OCULAR MOTILITY |
|
Diagnosis of Nystagmus and Saccadic Intrusions |
407 |
Treatments for Nystagmus and Saccadic Intrusionsists |
456 |
Skew Deviation and the Ocular Tilt Reaction (OTR) |
463 |
Disease of the Vestibular Periphery |
465 |
Oscillopsia |
479 |
Ocular Motor Syndromes Caused by Lesions in |
482 |
the Medulla |
|
Ocular Motor Syndromes Caused by Disease of |
487 |
the Cerebellum |
|