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The Cerebellar Dysplasia of Chiari II Malformation as Revealed by Eye Movements

Published online by Cambridge University Press:  02 December 2014

Michael S. Salman ,
Maureen Dennis  and
James A. Sharpe
Michael S. Salman*
Affiliation:
Section of Pediatric Neurology, Children's Hospital, University of Manitoba, Winnipeg, Manitoba
Maureen Dennis
Affiliation:
Program in Neurosciences and Mental Health, The Hospital for Sick Children University of Toronto, Toronto, Ontario, Canada
James A. Sharpe
Affiliation:
Division of Neurology, University Health Network University of Toronto, Toronto, Ontario, Canada
*
Section of Pediatric Neurology, Children's Hospital, AE 308, 820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada.
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Abstract

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Introduction:

Chiari type II malformation (CII) is a developmental deformity of the hindbrain. We have previously reported that many patients with CII have impaired smooth pursuit, while few make inaccurate saccades or have an abnormal vestibuloocular reflex. In contrast, saccadic adaptation and visual fixation are normal. In this report, we correlate results from several eye movement studies with neuroimaging in CII. We present a model for structural changes within the cerebellum in CII.

Methods:

Saccades, smooth pursuit, the vestibulo-ocular reflex, and visual fixation were recorded in 21 patients with CII, aged 8-19 years and 39 age-matched controls, using an infrared eye tracker. Qualitative and quantitative MRI data were correlated with eye movements in 19 CII patients and 28 controls.

Results:

Nine patients with CII had abnormal eye movements. Smooth pursuit gain was subnormal in eight, saccadic accuracy abnormal in four, and vestibulo-ocular reflex gain abnormal in three. None had fixation instability. Patients with CII had a significantly smaller cerebellar volume than controls, and those with normal eye motion had an expanded midsagittal vermis compared to controls. However, patients with abnormal eye movements had a smaller (non-expanded) midsagittal vermis area, posterior fossa area and medial cerebellar volumes than CII patients with normal eye movements.

Conclusions:

The deformity of CII affects the structure and function of the cerebellum selectively and differently in those with abnormal eye movements. We propose that the vermis can expand when compressed within a small posterior fossa in some CII patients, thus sparing its ocular motor functions.

Type
Other
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 6 , November 2009 , pp. 713 - 724
Copyright
Copyright © The Canadian Journal of Neurological 2009

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