总结分离性垂直偏斜(DVD)并垂直性斜视的诊断要点。在8例DVD 并垂直性斜视患儿的手术治疗中,观察到上直肌后徙后固定缝线术对 DVD的疗效较为肯定。而部份患者在行下斜肌后徙术后,DVD 减轻或消失了。认为:对 DVD 并垂直性斜视的患者,应...总结分离性垂直偏斜(DVD)并垂直性斜视的诊断要点。在8例DVD 并垂直性斜视患儿的手术治疗中,观察到上直肌后徙后固定缝线术对 DVD的疗效较为肯定。而部份患者在行下斜肌后徙术后,DVD 减轻或消失了。认为:对 DVD 并垂直性斜视的患者,应首先矫正垂直性斜视,根据术后 DVD 的变化情况,再决定是否行 DVD 矫正术。展开更多
Background: Skew deviation is typically caused by brainstem damage, and has not been identified with focal cerebellar lesions. This vertical strabismus has been attributed to asymmetric disruption of vestibuloocular r...Background: Skew deviation is typically caused by brainstem damage, and has not been identified with focal cerebellar lesions. This vertical strabismus has been attributed to asymmetric disruption of vestibuloocular reflex (VOR) projections from otolithic receptors of the utricle to ocular motoneurons, but asymmetry of the utriculo-ocular counter-roll reflex has not been detected. Methods: Lesions localized to the cerebellum were identified by MRI in five patients with vertical strabismus. Their skew deviation was measured by prism cover tests in all patients and by search coils in three patients. The angular VOR was tested in patients and 10 controls during sinusoidal ± 10 degree torsional, vertical, and horizontal head-on-body rotations at 0.5, 1, and 2 Hz. Static torsional VOR gain was measured by the change in torsional eye position divided by change in head position during maintained head tilt. Results: Static torsional VOR gains were asymmetric in each patient. Three patterns of asymmetry were identified: 1) decreased static gain in one eye in both directions; 2) decreased gains in both eyes in one direction; and 3) asymmetric gain in one direction in one eye alone. Dynamic torsional VOR gains were symmetrically reduced in both directions in both eyes in all patients. Conclusions: Focal cerebellar lesions can cause skew deviation. The static torsional vestibuloocular reflex (VOR) is linked to cerebellar control of vertical vergence. Asymmetry between the eyes or in direction of the static torsional VOR provides evidence that monocular or binocular imbalance of the utriculo-ocular reflex leads to cerebellar skew deviation.展开更多
文摘总结分离性垂直偏斜(DVD)并垂直性斜视的诊断要点。在8例DVD 并垂直性斜视患儿的手术治疗中,观察到上直肌后徙后固定缝线术对 DVD的疗效较为肯定。而部份患者在行下斜肌后徙术后,DVD 减轻或消失了。认为:对 DVD 并垂直性斜视的患者,应首先矫正垂直性斜视,根据术后 DVD 的变化情况,再决定是否行 DVD 矫正术。
文摘Background: Skew deviation is typically caused by brainstem damage, and has not been identified with focal cerebellar lesions. This vertical strabismus has been attributed to asymmetric disruption of vestibuloocular reflex (VOR) projections from otolithic receptors of the utricle to ocular motoneurons, but asymmetry of the utriculo-ocular counter-roll reflex has not been detected. Methods: Lesions localized to the cerebellum were identified by MRI in five patients with vertical strabismus. Their skew deviation was measured by prism cover tests in all patients and by search coils in three patients. The angular VOR was tested in patients and 10 controls during sinusoidal ± 10 degree torsional, vertical, and horizontal head-on-body rotations at 0.5, 1, and 2 Hz. Static torsional VOR gain was measured by the change in torsional eye position divided by change in head position during maintained head tilt. Results: Static torsional VOR gains were asymmetric in each patient. Three patterns of asymmetry were identified: 1) decreased static gain in one eye in both directions; 2) decreased gains in both eyes in one direction; and 3) asymmetric gain in one direction in one eye alone. Dynamic torsional VOR gains were symmetrically reduced in both directions in both eyes in all patients. Conclusions: Focal cerebellar lesions can cause skew deviation. The static torsional vestibuloocular reflex (VOR) is linked to cerebellar control of vertical vergence. Asymmetry between the eyes or in direction of the static torsional VOR provides evidence that monocular or binocular imbalance of the utriculo-ocular reflex leads to cerebellar skew deviation.
