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(Stroke. 1998;29:2377-2380.)
© 1998 American Heart Association, Inc.

Original Contributions

Unilateral Saccadic Pursuit in Patients With Sensory Stroke

Sign of a Pontine Tegmentum Lesion

Ken Johkura, MD; Shunsuke Matsumoto, MD; Atsushi Komiyama, MD; Osamu Hasegawa, MD; Yoshiyuki Kuroiwa, MD

From the Department of Neurology, Urafune Hospital, Yokohama City University, Yokohama (K.J., A.K.); the Department of Neurology, Higashimatsudo Municipal Hospital, Matsudo (S.M.); and the Department of Neurology, Yokohama City University School of Medicine, Yokohama (O.H., Y.K.), Japan.

Correspondence to Ken Johkura, MD, Department of Neurology, Urafune Hospital, Yokohama City University, 3-46 Urafune-cho, Minami-ku, Yokohama 232, Japan. E-mail kjm0502{at}urahp.yokohama-cu.ac.jp

Background and Purpose—Pure hemisensory syndrome can be caused by small strokes occurring in a number of regions, including the thalamus and pons. Differentiation of the pontine sensory syndrome from the thalamic sensory syndrome has generally been made on the basis of distribution of sensory loss and involvement of specific sensory modalities but not without uncertainties and difficulties. Because the pontine tegmentum plays a pivotal role in generating horizontal eye movement, we attempted to discriminate these 2 syndromes by analyzing horizontal eye movements in stroke patients with pure hemisensory syndrome.

Methods—Horizontal saccade, pursuit, vestibulo-ocular reflex (VOR), and VOR cancellation (VORC) were evaluated using electro-oculography in 6 patients with hemisensory syndromes, 3 due to pontine stroke and 3 due to thalamic stroke, and all were verified by MRI or CT. In addition, somatosensory evoked potentials (SEPs) were recorded.

Results—Smooth pursuit and VORC directed toward the side of the lesion were impaired unilaterally in patients with pontine sensory stroke, whereas those 2 movements were intact bilaterally in patients with thalamic sensory stroke. Saccade and VOR were preserved in all patients. SEPs were normal in all patients with pontine and thalamic sensory strokes. No difference was found in the pattern of sensory disturbance between the 2 types of stroke patients.

Conclusions—Ipsilateral impairment of the smooth pursuit system may be a sign of a pontine lesion in patients with hemisensory stroke.

Key Words: eye movements • pons • sensory stroke • thalamus