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December 1980, Vol 98, No. 12 >
ARTICLE | December 1980

Misdirection Revisited: Title and subTitle BreakA Critical Appraisal of Acquired Oculomotor Nerve Synkinesis FREE

Frederick E. Lepore, MD; Joel S. Glaser, MD
[+] Author Affiliations

Accepted for publication May 20, 1980.

Reprint requests to the Bascom Palmer Eye Institute, 900 NW 17th St, PO Box 016880, Miami, FL 33101 (Dr Glaser).


Arch Ophthalmol. 1980;98(12):2206-2209. doi:10.1001/archopht.1980.01020041058012
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References
Comments

• Two patients exhibiting "primary" oculomotor misdirection caused by intracavernous mass lesions, and a third boy with transient oculomotor synkinesis after migrainous ophthalmoplegia provide background for a reassessment of the currently accepted explanation of anomalous synkineses subsequent to oculomotor nerve palsies. The hypothesis of peripheral misdirection of regenerating motor axons is inconsistent with these clinical observations, and an alternate mechanism is suggested, based on concepts of ephaptic neuronal transmission of impulses or on chromatolysis-induced reorganization of nuclear synapses.

REFERENCES

1 +
Lipschitz R:  Beiträge zur lehre von der Facialislämung Nebst bemerkungen zur frage der Nervenregeneration . Monatschr Psychiatr Neurol 20( (suppl) ):85-95, 1906;.
2 +
Bielschowsky A:  Lectures on motor anomalies of the eyes: II. Paralysis of individual eye muscles . Arch Ophthalmol 13:33-59, 1935;.
3 +
Walsh FB, Hoyt WF: Clinical Neuro-ophthalmology , ed 3. Baltimore, Williams & Wilkins Co, 1969;, vol 1, p 257.
4 +
Schatz NJ, Savino PJ, Corbett JJ:  Primary aberrant oculomotor regeneration: A sign of intracavernous meningioma . Arch Neurol 34:29-32, 1977;.
5 +
Boghen D, Chartrand J-P, Laflamme P, et al:  Primary aberrant third nerve regeneration . Ann Neurol 6:415-418, 1979;.
6 +
Trobe JD, Glaser JS, Post JD:  Meningiomas and aneurysms of the cavernous sinus: Neuroophthalmologic features . Arch Ophthalmol 96:457-467, 1978;.
7 +
Glaser JS: Neuro-ophthalmology . Hagerstown, Md, Harper & Row Publishers Inc, 1978;, p 259.
8 +
Cogan DG: Neurology of the Ocular Muscles . Springfield, Ill, Charles C Thomas Publisher, 1956;, p 71.
9 +
Walsh FB:  Third nerve regeneration: A clinical evaluation . Br J Ophthalmol 41:577-598, 1957;.
10 +
Ramon y Cajal S: Degeneration and Regeneration of the Nervous System , May RM (trans). New York, Oxford University Press Inc, 1928;, p 276.
11 +
Kerns JM, Smith DR, Jannotta FS, et al:  Oculomotor nerve regeneration after aneurysm surgery . Am J Ophthalmol 87:225-233, 1979;.
12 +
Levin PM:  Intracranial aneurysms . Arch Neurol 67:771-786, 1952;.
13 +
Berry M, Riches AC:  An immunological approach to regeneration in the central nervous system . Br Med Bull 30:135-140, 1974;.
14 +
Crosby EC, Humphrey T, Lauer EW: Correlative Anatomy of the Nervous System . New York, Macmillan Publishing Co Inc, 1962;, p 46.
15 +
Lyle DJ:  Experimental oculomotor nerve regeneration . Am J Ophthalmol 61:1239-1243, 1966;.
16 +
Mark RF, Marotte LR:  On competitive innervation of goldfish eye muscle . Science 192:1145-1146, 1976;.
17 +
Czarnecki JSC, Thompson HS:  The iris sphincter in aberrant regeneration of the third nerve . Arch Ophthalmol 96:1606-1610, 1978;.
18 +
Barron KD: Regeneration, degeneration and recovery of function in the central nervous system . Chicago, American Academy of Neurology course, April 1979;.
19 +
Gay AJ, Brodkey J, Miller JE:  Convergence retraction nystagmus: An electromyographic study . Arch Ophthalmol 70:456-461, 1963;.
20 +
Loewenfeld IE, Thompson HS:  Oculomotor paresis with cyclic spasms: A critical review of the literature and a new case . Surv Ophthalmol 20:81-124, 1975;.
21 +
Grundfest H:  Synaptic and ephaptic transmission , in Quarton GC, Melnechuk T, Schmitt FO (eds): The Neurosciences: A Study Program . New York, Rockefeller University Press, 1967;, p 368.
22 +
Sheperd GM: The Synaptic Organization of the Brain . New York, Oxford University Press, 1979;, p 39.
23 +
Osterman PO, Westerberg CE:  Paroxysmal attacks in multiple sclerosis . Brain 98:189-202, 1975;.
24 +
Granit R, Leksell L, Skoglund CR:  Fibre interaction in injured or compressed region of nerve . Brain 67:125-139, 1944;.
25 +
De Lorenzo AJD:  Electron microscopy: Tight junctions in synapses of the chick ciliary ganglion . Science 152:76-78, 1966;.
26 +
Rasminsky M:  Ectopic generation of impulses and cross-talk in spinal nerve roots of 'dystrophic' mice . Ann Neurol 3:351-357, 1978;.
27 +
Wall PD, Waxman S, Basbaum AI:  Ongoing activity in peripheral nerve: Injury discharge . Exp Neurol 45:576-589, 1974;.
28 +
Grafstein B:  The nerve cell body response to axotomy . Exp Neurol 48:32-51, 1975;.
29 +
Ferguson JH:  Hemifacial spasm and the facial nucleus . Ann Neurol 4:97-103, 1978;.
30 +
Wartenberg R:  Associated movements in the oculomotor and facial muscles . Arch Neurol 55:439-488, 1946;.

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1 +
Lipschitz R:  Beiträge zur lehre von der Facialislämung Nebst bemerkungen zur frage der Nervenregeneration . Monatschr Psychiatr Neurol 20( (suppl) ):85-95, 1906;.
2 +
Bielschowsky A:  Lectures on motor anomalies of the eyes: II. Paralysis of individual eye muscles . Arch Ophthalmol 13:33-59, 1935;.
3 +
Walsh FB, Hoyt WF: Clinical Neuro-ophthalmology , ed 3. Baltimore, Williams & Wilkins Co, 1969;, vol 1, p 257.
4 +
Schatz NJ, Savino PJ, Corbett JJ:  Primary aberrant oculomotor regeneration: A sign of intracavernous meningioma . Arch Neurol 34:29-32, 1977;.
5 +
Boghen D, Chartrand J-P, Laflamme P, et al:  Primary aberrant third nerve regeneration . Ann Neurol 6:415-418, 1979;.
6 +
Trobe JD, Glaser JS, Post JD:  Meningiomas and aneurysms of the cavernous sinus: Neuroophthalmologic features . Arch Ophthalmol 96:457-467, 1978;.
7 +
Glaser JS: Neuro-ophthalmology . Hagerstown, Md, Harper & Row Publishers Inc, 1978;, p 259.
8 +
Cogan DG: Neurology of the Ocular Muscles . Springfield, Ill, Charles C Thomas Publisher, 1956;, p 71.
9 +
Walsh FB:  Third nerve regeneration: A clinical evaluation . Br J Ophthalmol 41:577-598, 1957;.
10 +
Ramon y Cajal S: Degeneration and Regeneration of the Nervous System , May RM (trans). New York, Oxford University Press Inc, 1928;, p 276.
11 +
Kerns JM, Smith DR, Jannotta FS, et al:  Oculomotor nerve regeneration after aneurysm surgery . Am J Ophthalmol 87:225-233, 1979;.
12 +
Levin PM:  Intracranial aneurysms . Arch Neurol 67:771-786, 1952;.
13 +
Berry M, Riches AC:  An immunological approach to regeneration in the central nervous system . Br Med Bull 30:135-140, 1974;.
14 +
Crosby EC, Humphrey T, Lauer EW: Correlative Anatomy of the Nervous System . New York, Macmillan Publishing Co Inc, 1962;, p 46.
15 +
Lyle DJ:  Experimental oculomotor nerve regeneration . Am J Ophthalmol 61:1239-1243, 1966;.
16 +
Mark RF, Marotte LR:  On competitive innervation of goldfish eye muscle . Science 192:1145-1146, 1976;.
17 +
Czarnecki JSC, Thompson HS:  The iris sphincter in aberrant regeneration of the third nerve . Arch Ophthalmol 96:1606-1610, 1978;.
18 +
Barron KD: Regeneration, degeneration and recovery of function in the central nervous system . Chicago, American Academy of Neurology course, April 1979;.
19 +
Gay AJ, Brodkey J, Miller JE:  Convergence retraction nystagmus: An electromyographic study . Arch Ophthalmol 70:456-461, 1963;.
20 +
Loewenfeld IE, Thompson HS:  Oculomotor paresis with cyclic spasms: A critical review of the literature and a new case . Surv Ophthalmol 20:81-124, 1975;.
21 +
Grundfest H:  Synaptic and ephaptic transmission , in Quarton GC, Melnechuk T, Schmitt FO (eds): The Neurosciences: A Study Program . New York, Rockefeller University Press, 1967;, p 368.
22 +
Sheperd GM: The Synaptic Organization of the Brain . New York, Oxford University Press, 1979;, p 39.
23 +
Osterman PO, Westerberg CE:  Paroxysmal attacks in multiple sclerosis . Brain 98:189-202, 1975;.
24 +
Granit R, Leksell L, Skoglund CR:  Fibre interaction in injured or compressed region of nerve . Brain 67:125-139, 1944;.
25 +
De Lorenzo AJD:  Electron microscopy: Tight junctions in synapses of the chick ciliary ganglion . Science 152:76-78, 1966;.
26 +
Rasminsky M:  Ectopic generation of impulses and cross-talk in spinal nerve roots of 'dystrophic' mice . Ann Neurol 3:351-357, 1978;.
27 +
Wall PD, Waxman S, Basbaum AI:  Ongoing activity in peripheral nerve: Injury discharge . Exp Neurol 45:576-589, 1974;.
28 +
Grafstein B:  The nerve cell body response to axotomy . Exp Neurol 48:32-51, 1975;.
29 +
Ferguson JH:  Hemifacial spasm and the facial nucleus . Ann Neurol 4:97-103, 1978;.
30 +
Wartenberg R:  Associated movements in the oculomotor and facial muscles . Arch Neurol 55:439-488, 1946;.

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