We investigated the horizontal and the vertical otolith-ocular reflex induced by off-vertical-axis rotation and subjective visual vertical in 14 patients with skew deviation due to brain stem lesion. Patients were divided into two groups: the group C ( N = 7) with caudal brain stem lesions and the group R ( N = 7) with rostral brain stem lesions as defined by the midpons level. The patient group was compared to a control group of 20 healthy subjects. The otolith-ocular reflex was evoked by constant velocity rotation in yaw plane around an axis tilted at 15 deg with respect to gravity. In group C, the horizontal off-vertical-axis nystagmus bias was negative i.e. anticompensatory to chair rotation, when directed toward the lesioned side. Furthermore, patients of group C were presenting with a significant tilt of subjective visual vertical. In group R, a vertical downward offset was induced predominantly in the hypotropic eye and in the direction of rotation away from the lesion. Finally, in patients of group R, horizontal and vertical modulation was increased for rotation away from the lesion. These results are discussed in terms of 1) asymmetrical horizontal and vertical dynamic otolith signals feeding the velocity storage network after brain stem lesion, 2) possible involvement of cerebellar function in OVAN modulation.
BSR in the Topographical Differential Diagnosis of the Brain Stem Lesions
