Wallenberg's syndrome: Lateropulsion, cyclorotation, and subjective visual vertical in thirty‐six patients

TLDR

The study hypothesizes that deviations in subjective visual vertical, body lateropulsion, and eye cyclorotation are perceptual, postural, and ocular motor consequences of a common lesion in central vestibular pathways mediating the vestibulo‑ocular reflex in the roll plane. The authors measured subjective visual vertical, eye cyclorotation, and head/body lateropulsion in 36 Wallenberg's syndrome patients. All 36 patients showed ipsiversive subjective visual vertical tilts, 82 % had ipsiversive cyclorotation (especially excyclotropia ipsilateral to the lesion), and 33 % displayed a complete ocular tilt reaction with head tilt, skew deviation, and roll‑plane cyclorotation, indicating that lateropulsion reflects a postural consequence of an abnormal internal orientation tilt.

Abstract

We measured the subjective visual vertical, cyclorotation of the eyes, and head and body lateropulsion in 36 patients with Wallenberg's syndrome. All patients exhibited significant tilts of the internal representation of the gravity vector, as indicated by deviation of subjective visual vertical ipsiversive to the lesion. Most patients (82%) had ipsiversive cyclorotation of one or both eyes, especially excyclotropia of the eye ipsilateral to the brainstem lesion. Twelve of 36 patients (33%), those with the most severe body lateropulsion, had a complete ocular tilt reaction consisting of head tilt, skew deviation, and cyclorotation in the roll plane. We hypothesize that deviation of subjective visual vertical, lateropulsion of the body, and cyclorotation of the eyes are the perceptual, the ocular motor, and the postural consequences of a common lesion of central vestibular pathways that subserve the vestibuloocular reflex in the roll plane. Lateropulsion in patients with Wallenberg's syndrome is interpreted as a postural consequence of an abnormal tilt of the internal representation of orientation in space.