Saccades Rapid eye movements to change foveal fixation Large Saccades may be faster than 500o / sec and last 100 ms the cerebellum also influences the latency of saccades.
Saccades Rapid eye movements to change foveal fixation Large Saccades may be faster than 500o / sec and last 100 ms the cerebellum also influences the latency of saccades.
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Saccades Rapid eye movements to change foveal fixation Large Saccades may be faster than 500o / sec and last 100 ms the cerebellum also influences the latency of saccades.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online from Scribd
fixation • Large saccades may be faster than 500º/sec and last < 100 ms • The cerebellum calibrates for the best visuo-ocular motor behavior – saccadic amplitude in the dorsal vermis and fastigial nucleus – Saccadic pulse step match in the flocculus • Cerebellum also influences the latency of saccades Saccades • Square-Wave Jerks – Pairs of small horizontal saccades pulling the eye off target and then back • with in 200 – 400 ms • Typically .5º (range 0.1 - 4.0) • Typically occur in a series – More common in older population – Found in certain cerebellar syndromes • PSP (progressive supernuclear palsy) – Are very frequent – Increase in frequency in cigarette smoking – Increase in dementia patients due to distractibility Saccades • Ocular Flutter – Intermittent conjugate bursts of saccades – Have no inter-saccadic interval – May be micro-flutter • So tiny only visible if zoom • (or look at with ophthalmoscope) – Causes: • Parainfections encephalitis • Paraneoplastic syndromes • Meningitis • Intracranial tumors • Hydrocephalus • MS • Systemic disease Saccades • Causes Continued (Ocular Flutter) – Drug side effects: lithium, imitriptyline, cocaine, phenytoin w/ diazepam, phenelzine w/ imipramine – Toxins: chlordecone, thallium, strychnine, toluene, organophosphates – Complication of pregnancy – Transient normal phenomenon in infants – And in conditions we would not be testing » Thalamic Hemorrhage » Hypersmolar coma Saccades • Macro-Saccades (Macrosquare-wave Jerks, or Macrosaccadic Pulses) – Large Saccades that pull the eye off target and return it within 70-150 ms – Usually 5-15º and vary in amplitude – Occur in light or dark – Usually suppressed by monocular fixation – MS and multiple system atrophy Saccades • Macro-Saccadic Oscillations – Hypermetric saccades (oscillations) that come and go with an inter-saccadic interval of 200 ms – Happen when fixating on a point – Occur most often with lesions of fastigial nucleus and its output in the cerebellar peduncles • some forms of spinocerebellar ataxia • Occasionally with pontine lesions (if compromise the Saccades • Saccadic Pulses – Brief small saccade away from the target followed by a rapid drift back (glissade) • Due to lack of saccadic step • INO • Opsoclonus – Multidirectional (horizontal, vertical and torsional) saccadic oscillations – Has no intersaccadic interval – Causes are similar to Ocular Flutter • Voluntary Nystagmus – High frequency (15-25º/sec) – Conjugate horizontal oscillations – <30 seconds sustained – Usually brought about by fixation Opsoclonus Opsoclonus Saccades • Random Saccades: – Individual eye movement recordings made – Calibrate each separately (when recording each) – Done on computerized systems – Position of target randomized from 0-30 degrees to the right or left of center – Timing randomized – Gives reactionary saccades • Analysis – Accuracy – Latency – Velocity Saccades Shepard & Telian 1996 Saccades • Saccade Velocity Abnormalities – Overall slowing in both directions (conjugate or individual eye recordings) • Medications/ drowsiness/ fatigue • Basal ganglia when latency is increased with accuracy undershoot abnormality • Brainstem (PPRF) when latency increased • Cerebellar – Ex. Olivopontocerebellar atrophy • Bilateral internuclear opthalmoplegia Slow Saccades Saccadic Slowing Saccades • Saccade Velocity Abnormalities – Abnormally fast • Calibration error • Restriction syndromes – (mechanical condition limiting range of motion of eye but not velocity) – Asymmetrical Velocity • Restriction syndromes • Internuclear Opthalmoplegia Saccade Velocity Abnormalities • Localization Summary: – Lesion of: • Basal ganglia • Brainstem • Cerebellum • Peripheral oculomotor nerves or muscles – Rule out: • Inattention • Fatigue • Medications Saccades • Internuclear Opthalmoplegia – Caused by a lesion to the MLF – Affects both horizontal and vertical eye movements – Cardinal sign • Paresis of adduction by the eye on the side of the MLF lesion during conjugate eye movement • Look for saccadic slowing of adducting movement… adduction lag – Nystagmus on abduction of the eye contralateral to the lesion Saccades • INO – Differential degrees cause… • Paralysis of adduction or paresis only apparent as slowing of adducting saccades • Disconjugacy of quick phase with slowing of adducting eye – Very positive for INO • Convergence may be preserved or impaired • Skew deviation may be present • Dissociated vertical nystagmus – Downbeat in ipsi eye and torsional in contra eye may be present Saccades • INO Etiology – Unilateral INO • Most commonly related to ischemia – Bilateral INO • Most commonly due to demyelination associated with MS – Other causes • Brainstem and 4th ventricular tumors and mesencephalic clefts • Arnold-Chiari malformation and associated hydrocephalus and syringobulbia • Infection: meningoencephalitis – Viral, bacterial, AIDS Saccades • INO – Other causes continued • Hydrocephalus, subdural hematoma, supratentorial arteriovenous malformation • Nutritional disorders • Metabolic disorders • Drug intoxications • Cancer • Head trauma • Degenerative conditions • Syphilis • Pseudo-INO of Myasthenia gravis INO
Bilateral INO Unilateral INO
INO INO Saccade Accuracy • Overshoot Dysmetria (lack of coordination of movement) (Hypermetric saccades) – CPA pathological process • Ipsilateral eye movements – Cerebellar (fastigial nuclei) • Bilateral eye movements – INO (ipsi to MLF lesion) – Visual field deficits • Undershoot Dysmetria (Hypometric saccades) – Cerebellar (dorsal vermis) • Bilateral eye movements – Basal ganglia • When velocity is slowed and latency is increased Saccades- Hypometric Saccades - Hypermetric Saccade Accuracy • Glissades (eye velocity slows just prior to reaching the target and the eye gradually acquires the target or steps with a small additional saccade) – Cerebellar • Unilateral or bilateral – Muscle or nerve weakness – Rule out head movement during test Saccade Accuracy • Ocular-lateral pulsion – Saccades that are too large in one direction and too small in the other direction • Posterior Inferior Cerebellar Artery (PICA) distribution involvement (ipsilateral-medullary syndrome) – Ipsipulsion: overshoots toward the side of the lesion and undershoots away from the side of the lesion Ocular-lateral pulsion continued • Infarcts in the distribution of the superior cerebellar artery – Contrapulsion: overshoots away from side of lesion and undershoots toward the side of lesion – Most labs do not attempt to record this Lateropulsion Saccade Latency • Overall increased latency – Inattention/ medication / drowsiness – Basal ganglia when velocity is slowed and ocular dysmetria with undershoots present – Brainstem (PPRF) when velocity reduced – Seen in Parkinson’s disease for volitional saccade tasks not reactionary • Asymmetrical latency – Parietal or occipital lobe involvement • Ex. CVA Saccade Latency - Overall Increased Other Saccade Abnormalities • Antisaccade abnormality – Frontoparietal cortex • Remembered saccade abnormality – Dominantly frontal (secondary parietal) cortex Analysis - Saccades Analysis - Saccades • Saccade V Limits – Adjust lower and upper saccade velocity threshold limits. The data segments that are excluded will be highlighted in red. • Min Delay – minimum time delay after stimuli motion occurrence that a patient response (saccade) can be classified as valid (default: 0.08 sec) • Max Delay – maximum time delay after stimuli motion occurrence that a patient response (saccade) can be classified as valid (default: 0.6 sec) • Min Duration – minimum step duration to be classified as a valid saccade (default: 0.04 sec) • Min Peak Saccade V – minimum peak velocity to be a classified as a valid saccade (default: 60º/sec) Analysis - Saccades • Saccade Results: – Latency • time between target stimuli motion and the beginning of the saccade (sec) – Duration • time that the saccade velocity remains greater than the minimum velocity (sec) – Amplitude • difference between eye position at the beginning and the end of the saccade (deg) – Max velocity • maximum saccade eye velocity (deg/sec) – Gain • ratio between eye position and laser dot position for each saccade (%) Saccade, norms