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Saccades

• Rapid eye movements to change foveal


fixation
• Large saccades may be faster than
500º/sec and last < 100 ms
• The cerebellum calibrates for the best
visuo-ocular motor behavior
– saccadic amplitude in the dorsal vermis and
fastigial nucleus
– Saccadic pulse step match in the flocculus
• Cerebellum also influences the latency of
saccades
Saccades
• Square-Wave Jerks
– Pairs of small
horizontal saccades
pulling the eye off
target and then back
• with in 200 – 400 ms
• Typically .5º (range 0.1
- 4.0)
• Typically occur in a
series
– More common in older
population
– Found in certain
cerebellar syndromes
• PSP (progressive
supernuclear palsy)
– Are very frequent
– Increase in frequency
in cigarette smoking
– Increase in dementia
patients due to
distractibility
Saccades
• Ocular Flutter
– Intermittent conjugate bursts of saccades
– Have no inter-saccadic interval
– May be micro-flutter
• So tiny only visible if zoom
• (or look at with ophthalmoscope)
– Causes:
• Parainfections encephalitis
• Paraneoplastic syndromes
• Meningitis
• Intracranial tumors
• Hydrocephalus
• MS
• Systemic disease
Saccades
• Causes Continued (Ocular Flutter)
– Drug side effects: lithium, imitriptyline, cocaine,
phenytoin w/ diazepam, phenelzine w/ imipramine
– Toxins: chlordecone, thallium, strychnine, toluene,
organophosphates
– Complication of pregnancy
– Transient normal phenomenon in infants
– And in conditions we would not be testing
» Thalamic Hemorrhage
» Hypersmolar coma
Saccades
• Macro-Saccades (Macrosquare-wave Jerks, or
Macrosaccadic Pulses)
– Large Saccades that pull the eye off target and
return it within 70-150 ms
– Usually 5-15º and vary in amplitude
– Occur in light or dark
– Usually suppressed by monocular fixation
– MS and multiple system atrophy
Saccades
• Macro-Saccadic
Oscillations
– Hypermetric saccades
(oscillations) that
come and go with an
inter-saccadic interval
of 200 ms
– Happen when fixating
on a point
– Occur most often with
lesions of fastigial
nucleus and its output
in the cerebellar
peduncles
• some forms of
spinocerebellar ataxia
• Occasionally with
pontine lesions (if
compromise the
Saccades
• Saccadic Pulses
– Brief small saccade away from the target followed
by a rapid drift back (glissade)
• Due to lack of saccadic step
• INO
• Opsoclonus
– Multidirectional (horizontal, vertical and torsional)
saccadic oscillations
– Has no intersaccadic interval
– Causes are similar to Ocular Flutter
• Voluntary Nystagmus
– High frequency (15-25º/sec)
– Conjugate horizontal oscillations
– <30 seconds sustained
– Usually brought about by fixation
Opsoclonus
Opsoclonus
Saccades
• Random Saccades:
– Individual eye movement recordings made
– Calibrate each separately (when recording each)
– Done on computerized systems
– Position of target randomized from 0-30 degrees
to the right or left of center
– Timing randomized
– Gives reactionary saccades
• Analysis
– Accuracy
– Latency
– Velocity
Saccades
Shepard & Telian 1996
Saccades
• Saccade Velocity Abnormalities
– Overall slowing in both directions (conjugate or
individual eye recordings)
• Medications/ drowsiness/ fatigue
• Basal ganglia when latency is increased with
accuracy undershoot abnormality
• Brainstem (PPRF) when latency increased
• Cerebellar
– Ex. Olivopontocerebellar atrophy
• Bilateral internuclear opthalmoplegia
Slow Saccades
Saccadic Slowing
Saccades
• Saccade Velocity Abnormalities
– Abnormally fast
• Calibration error
• Restriction syndromes
– (mechanical condition limiting range of motion of
eye but not velocity)
– Asymmetrical Velocity
• Restriction syndromes
• Internuclear Opthalmoplegia
Saccade Velocity
Abnormalities
• Localization Summary:
– Lesion of:
• Basal ganglia
• Brainstem
• Cerebellum
• Peripheral oculomotor nerves or muscles
– Rule out:
• Inattention
• Fatigue
• Medications
Saccades
• Internuclear Opthalmoplegia
– Caused by a lesion to the MLF
– Affects both horizontal and vertical eye
movements
– Cardinal sign
• Paresis of adduction by the eye on the side
of the MLF lesion during conjugate eye
movement
• Look for saccadic slowing of adducting
movement… adduction lag
– Nystagmus on abduction of the eye
contralateral to the lesion
Saccades
• INO
– Differential degrees cause…
• Paralysis of adduction or paresis only
apparent as slowing of adducting saccades
• Disconjugacy of quick phase with slowing
of adducting eye
– Very positive for INO
• Convergence may be preserved or
impaired
• Skew deviation may be present
• Dissociated vertical nystagmus
– Downbeat in ipsi eye and torsional in
contra eye may be present
Saccades
• INO Etiology
– Unilateral INO
• Most commonly related to ischemia
– Bilateral INO
• Most commonly due to demyelination
associated with MS
– Other causes
• Brainstem and 4th ventricular tumors and
mesencephalic clefts
• Arnold-Chiari malformation and associated
hydrocephalus and syringobulbia
• Infection: meningoencephalitis
– Viral, bacterial, AIDS
Saccades
• INO
– Other causes continued
• Hydrocephalus, subdural hematoma,
supratentorial arteriovenous malformation
• Nutritional disorders
• Metabolic disorders
• Drug intoxications
• Cancer
• Head trauma
• Degenerative conditions
• Syphilis
• Pseudo-INO of Myasthenia gravis
INO

Bilateral INO Unilateral INO


INO
INO
Saccade Accuracy
• Overshoot Dysmetria (lack of coordination of
movement) (Hypermetric saccades)
– CPA pathological process
• Ipsilateral eye movements
– Cerebellar (fastigial nuclei)
• Bilateral eye movements
– INO (ipsi to MLF lesion)
– Visual field deficits
• Undershoot Dysmetria (Hypometric saccades)
– Cerebellar (dorsal vermis)
• Bilateral eye movements
– Basal ganglia
• When velocity is slowed and latency is
increased
Saccades- Hypometric
Saccades - Hypermetric
Saccade Accuracy
• Glissades (eye velocity slows just prior to
reaching the target and the eye gradually
acquires the target or steps with a small
additional saccade)
– Cerebellar
• Unilateral or bilateral
– Muscle or nerve weakness
– Rule out head movement during test
Saccade Accuracy
• Ocular-lateral pulsion
– Saccades that are too large in one
direction and too small in the other
direction
• Posterior Inferior Cerebellar Artery
(PICA) distribution involvement
(ipsilateral-medullary syndrome)
– Ipsipulsion: overshoots toward the
side of the lesion and undershoots
away from the side of the lesion
Ocular-lateral pulsion
continued
• Infarcts in the distribution of the superior
cerebellar artery
– Contrapulsion: overshoots away from side of
lesion and undershoots toward the side of lesion
– Most labs do not attempt to record this
Lateropulsion
Saccade Latency
• Overall increased latency
– Inattention/ medication / drowsiness
– Basal ganglia when velocity is slowed and
ocular dysmetria with undershoots present
– Brainstem (PPRF) when velocity reduced
– Seen in Parkinson’s disease for volitional
saccade tasks not reactionary
• Asymmetrical latency
– Parietal or occipital lobe involvement
• Ex. CVA
Saccade Latency - Overall
Increased
Other Saccade
Abnormalities
• Antisaccade abnormality
– Frontoparietal cortex
• Remembered saccade abnormality
– Dominantly frontal (secondary parietal)
cortex
Analysis - Saccades
Analysis - Saccades
• Saccade V Limits
– Adjust lower and upper saccade velocity threshold
limits. The data segments that are excluded will be
highlighted in red.
• Min Delay
– minimum time delay after stimuli motion occurrence
that a patient response (saccade) can be classified as
valid (default: 0.08 sec)
• Max Delay
– maximum time delay after stimuli motion occurrence
that a patient response (saccade) can be classified as
valid (default: 0.6 sec)
• Min Duration
– minimum step duration to be classified as a valid
saccade (default: 0.04 sec)
• Min Peak Saccade V – minimum peak velocity to be a
classified as a valid saccade (default: 60º/sec)
Analysis - Saccades
• Saccade Results:
– Latency
• time between target stimuli motion and the
beginning of the saccade (sec)
– Duration
• time that the saccade velocity remains greater
than the minimum velocity (sec)
– Amplitude
• difference between eye position at the beginning
and the end of the saccade (deg)
– Max velocity
• maximum saccade eye velocity (deg/sec)
– Gain
• ratio between eye position and laser dot position
for each saccade (%)
Saccade, norms