Infantile strabismus inaugurates a constellation of dissociated eye movements that correspond to visuovestibular reflexes in lateral-eyed animals. These visual reflexes are generated by subcortical visual pathways that use binocular visual input to modulate central vestibular tone. In this article, I present evidence that the accessory optic system is uniquely suited to provide an innervational substrate for visuovestibular eye movements in humans with infantile strabismus.
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Figure 1. Neuroanatomical connections of the accessory optic system. The brainstem is depicted from the front (with the left-hand side of the animal on the right-hand side of the drawing). Accessory terminal nuclei include the dorsoterminal nucleus (DTN), which lies adjacent to the nucleus of the optic tract (NOT); medial terminal nucleus (MTN); lateral terminal nucleus (LTN); and principal part of the inferior olive (IOp). Optokinetic input from the right retina crosses to the left accessory optic nuclei (depicted), which send ipsilateral projections to the left dorsal cap (DC) of the inferior olive and then back to the right flocculus (not shown), resulting in a double decussation of motion pathways from each eye. Adapted with permission from Simpson et al.12 CP indicates posterior commissure; D, nucleus of Darkschewitsch; DMNm, deep mesencephalic nucleus, pars medialis; EW, nucleus of Edinger-Westphal; INC, interstitial nucleus of Cajal; inSFp, intersitial nucleus of the superior fasciculus, posterior fibers; MAO, medial accessory nucleus, inferior olivary complex; ML, medial lemniscus; MLF, medial longitudinal fasciculus; PAGm, periaqueductal gray, medial part; pdl, dorsolateral division, basal pontine complex; pm, medial division, basal pontine complex; pv, ventral division, basal pontine complex; PVG, periventricular gray; RN, red nucleus; rpc, pontine reticular nucleus, pars caudalis; rpo, pontine reticular nucleus, pars oralis; vl, lateral vestibular nucleus; VLO, ventrolateral outgrowth, inferior olivary complex; vm, medial vestibular nucleus; vs, superior vestibular nucleus; vsp, spinal vestibular nucleus; VTRZ, visual tegmental relay zone; β, nucleus β of the inferior olive; 3n, oculomotor nerve; 4n, trochlear nerve; and 6n, abducens nerve.
Figure 2. Spatial orientation of preferred axes of 3-dimensional rotation for dorsal cap neurons in the right inferior olive recorded during optokinetic stimulation in a spherical enclosure. Adapted with permission from Van der Steen et al.27 VA indicates vertical axis.
Figure 3. Sensitivity to monocular optokinetic stimulation in a spherical enclosure. A, Responses of posterior axis climbing fiber Purkinje cells to stimulation presented to the ipsilateral left eye. B, Responses of anterior axis climbing fiber Purkinje cells to stimulation presented to the contralateral eye. CCW indicates counterclockwise optokinetic rotation; CW, clockwise optokinetic rotation. Adapted with permission from Van der Steen et al.27
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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