Ординатура / Офтальмология / Английские материалы / The Neurology of Eye Movements_Leigh, Zee_2006

tion in the future, it may be possible to define their role. Isolated lesions of the superior colliculus are reported to cause increased latency and inaccuracy of visually guided saccades259 and a paucity of spontaneous saccades contralateral to the side of the lesion.126 As previously summarized, frontal lobe lesions in humans cause hypometria of visually guided and mem- ory-guided saccades contralateral to the lesion and impairment of smooth pursuit of targets moving towards the side of the lesion. No reports exist of combined lesions of the frontal eye fields and superior colliculi in humans. However, combined lesions of frontal and parietal cortex cause loss of ability to make voluntary saccades, or ocular motor apraxia (see VIDEO: "Acquired ocular motor apraxia").251 Overall, it seems likely that during normal ocular motor behavior, the frontal and parietal lobes of humans complement each other. The FEFs direct the eyes towards an object or a location of behavioral interest, while the parietal lobes are more concerned with reflexively induced saccades. Finally, although the contributions of the FEF, parietal lobes and superior colliculus have been defined best for saccades, it seems likely that each of these areas influences all types of eye movements.

SUMMARY

1.The abducens nucleus is the center for conjugate, horizontal eye movements and receives inputs for each functional class of eye movement (Fig. 6-1). The abducens nucleus contains two groups of neurons: motoneurons that send axons to the ipsilateral lateral rectus muscle, and internuclear neurons that project, via the contralateral medial longitudinal fasciculus, to synapse in the oculomotor nucleus on medial rectus motoneurons. The abducens motoneurons and internuclear neurons receive inputs for horizontal saccades from the PPRF, vestibular and pursuit inputs from the vestibular nuclei, and the gaze-hold- ing signal from the prepositus-medial vestibular nuclear complex.

2.The oculomotor and trochlear nuclei receive inputs for vertical saccades from the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), which lies in the prerubral fields (Fig. 6-5). The interstitial nucleus of Cajal (INC) is important for vertical gaze holding. Vertical vestibular and pursuit signals ascend to the oculomotor and trochlear nuclei from the lower brain stem.

3.The cerebellum (Fig. 6-6) ensures that all classes of eye movements and gaze holding are calibrated to provide clearest vision. The vestibulocerebellum, which consists of the flocculus, paraflocculus, and nodulus, is important for steady gaze holding, smooth ocular tracking, and optimal performance of the vestibulo-ocular reflex. The dorsal vermis and underlying fastigial nucleus have an important role in programing accurate saccades and smooth pursuit.

4.Primary visual cortex is essential for accurate saccades and for generating smooth pursuit and optokinetic eye movements. The parietal-occipital- temporal lobe junction contains secondary visual areas important for detecting the speed and direction of moving targets and generating an

eye-tracking response. This area of posterior cortex gives rise to an ipsilateral pathway to brain stem and cerebellum, which is important for smooth-pursuit eye movements (Fig. 6-7).

5.Parietal cortical areas contribute to shifting visual attention and also to initiating saccades (Fig. 6-8). The visual responses of some neurons in parietal cortex are influenced by the current direction of gaze. The dorsomedial pulvinar projects to parietal cortex and contributes to shifts of attention.

6.Frontal cortex contains three areas that contribute to programing of saccades (Fig. 6-8). The frontal eye field (FEF) contains neurons that discharge before visually guided and memory-guided saccades. The dorsomedial, supplementary motor area

appears to be important for control of learned ocular motor behaviors. Dorsolateral prefrontalcortex (DLPC) probably contributes to programing of saccades to remembered target locations.

7.The eye fields of the frontal lobes project in parallel descending pathways to the superior colliculus, the brain stem reticular formation, and, via pontine nuclei, to the cerebellum (Fig. 6-9). Indirect pathways involve the caudate nuclei and the pars reticulata of the substantia nigra (SNpr). Combined lesions of the frontal eye fields and the parietal eye fields, or of the frontal eye fields and the superior colliculi, cause profound and enduring ocular motor deficits.

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