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Ataxia and nystagmus induced by injection of local anesthetics in the neck.

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Ataxia and Nystagmus Induced by
Injection of Local Anesthetics in the Neck
Paul T. V. M. d e Jong, MD, J. M. B. Vianney de Jong, MD,
Bernard Cohen, MD, and Leonard B. W. Jongkees, MD
Vertigo, ataxia, and nystagnius were induced in animals and man by injecting local anesthetics into the neck. This
presumably interrupted the flow of afferent information from neck muscle and joint receptors. Ataxia in man was
associated with a broad-based, staggering gait; hypotonia of the ipsilateral arm and leg; and a strong sensation of
ipsilateral falling or tilting. Nystagmus was stronger in the rabbit and cat than in the monkey and was not induced in
man. In the rabbit, section ofthe cervical roots on one side reactivated signs of a previous labyrinthectomy, regardless
of the side of operation. Neck-afferent nystagmus was not dependent on the cerebellum, and the activity responsible
for it appeared to ascend ipsilaterally through ventral portions of the cervical spinal cord. The data demonstrate the
dependence of neck-afferent nystagmus on the vestibular system and suggest that in the presence of previous
vestibular lesions, neck joint or muscle disorders may be a cause of clinical vertigo, ataxia, or nystagmus.
de Jong PTVM, de Jong JMBV, Cohen B, et al: Ataxia and nystagmus induced by injection of local
ancschetics in the neck. A n n Neurol 1:240-246, 1977
While it is clear that vertigo, nystagmus, and ataxia can
be produced by constriction of the vertebral arteries
in the transverse foramen of the cervical spine, clinical
data have not been presenced that incontrovertibly
link similar symptoms in man to direct involvement of
the muscles and joints of the cervical vertebrae. Cervical ataxia was first described over a century ago
[1-3] and has been found more recently [4-7]. Despite this, it is not mentioned in current textbooks.
In addition to ataxia, Biemond [8, 91 found vertigo
and positional nystagmus in 5 patients with unilateral
cervicobrachial radiculoneuritis. H e also elicited positional nystagmus by sectioning dorsal roots C1 to C4
in rabbits and considered it a sign of cervical root
involvement. Kornhuber [ 51 performed intradural
section of the upper posterior cervical roots in the cat
and observed severe ataxia but n o nystagmus. He
raised the possibility that the positional nystagmus
described by Biemond was due to the use of ether
narcosis. Kornhuber [ l o ] also noted that the neck
reflexes are considerably stronger in the rabbit than in
man and questioned whether findings in one are applicable to the other.
O n e possible reason for the paucity of information
about oculomotor o r postural effects of changes in
cervical joint and muscle sensation i s that the receptors are dispersed in the neck. This makes it difficult to
measure or alter the flow of afferent impulses predictably or to stimulate the receptors in unanesthesized
animals without causing pain. A useful technique for
altering the flow of afferent information from deep
cervical joint, ligament, and muscle receptors is injection of local anesthetics into the tissues of the neck.
Such injections cause positional nystagmus in rabbit
[6, 71 and severe ataxia in the monkey [ 4 ] .W e have
designated these signs neck-afferent nyrtugmzrs and
rltuxzu because presumably they are due to blockade
of afferent activity arising in cervical joint and muscle
receptors. In this study, unilateral neck injections
were used to provide comparative data on ataxia, vertigo, and nystagmus in the cat, rabbit, monkey, and
man. The aim was to understand more about similar
signs and symptoms that might be induced by cervical
lesions. Experiments were also done to determine the
location of tracts in the brainstem that carry activity
responsible for neck-afferent nystagmus.
From the Departments of Experimental Neurology, Ophthalmoland
University Of Amsterdam, the Necherland%and the
Department of Neurology, Mount Sinai School of Medicine of the
City University of New York, N e w York, NY.
Accepted for publication Sept
Materials and Method
Rabbits, cats, rhesus monkeys (Maraca mzflattaj , and humans were used in the study. Informed consent was obtained from the human subjects after t h e nature of the
procedure had been fully explained. I n animals, local anesthetics were injected alternately on either side of the neck at
intervals not less than 12 hours apart. Rabbits and cats
received 1.5 to 2 ml of a 2':; procaine chloride solution,
Address reprinr requests to Dr Cohen, D~~~~~~~~~
Mount Sinai School of Medicine, Fifth Ave at 100th St, New York,
N Y 10029.
monkeys received 1 to 2 ml o f a 1 lidocaine hydrochloride
solution, and 10 ml of 15: lidocaine was injected in humans.
To control for the mass effects of injections, the same volumes of saline were injected at similar places in the neck. To
control for the systemic effects of the local anesthetics, the
same volumes were injected into thigh muscles.
The technique of neck injection in the rabbit and cat has
been described in detail [ 7 ] .I n monkey and man the needle
was directed toward the cervical column to prevent inadvertent penetration of the dura [4j. A palpable tuberosity 011
the superior nuchal line was used for a landmark in the
monkey (Fig l), and the anesthetic was deposited in the
immediate neighborhood of the occipital condyle. The
paravertebral tissues of the human subjects were infiltrated
halfway between the mastoid process and the carotid tubercle at the level of the second and third cervical vertebrae.
Eye movements were observed behind Frenzel glasses
and were recorded in light and dark using electrooculography (EOG). In monkeys the EOG potentials were differentiated to measure angular eye velocity [ I 1, 121, and
slow-phase eye velocity was integrated to obtain total deviation of the eyes during nystagmus [ 13j . In cats and rabbits,
quick-phase amplitudes were summed to obtain total deviation,
Humans and animals were tested for spontaneous nystagmus in light and darkness and for positional npstagmus in
darkness. If spontaneous nystagmus was present following
CNS or labyrinthine lesions, total deviation over 30 seconds
was measured before and after neck infiltration. If it had at
least doubled, this was taken to mean that additional nystagmus had been produced by the cervical block. Caloric
nystagmus was induced in monkeys by injecting 15 ml of
cold or hot water (4", 31.5", 45.5"C) into the external
auditory meatus over a 10-second period. Caloric nystagrnus was recorded in darkness. Optokinetic nystagmus
(OKN) was induced with monkeys sitting in the center of an
internally lighted drum that filled the field of vision. The
OKN drum was rotated at constant velocities for 30-second
periods [12, 141. Nystagmus intensity was measured by
calculating mean maximum slow-phase velocity for 3 0 consecutive beats. Differences of more than 30c.i, were considFrg I. SkuII of Macaca mulattashou z n g tubevoritjl o j the
superzor nuchal Izrir andJite o j r n p t i o r t ojloca/anr\thrtii
Tuberosity of
linea nuchae superior
ered significant. Optokinetic after-nystagmus (OKAN)was
also recorded.
To maintain alertness, monkeys and cats were given
amphetamine sulfate (0.5 mgikg) before testing. Each of the
7 normal monkeys used in this study had weak positional
nystagmus in darkness. Their eardrums were intact, and
there was no directional or labyrinthine predominance of
caloric nystagmus or OKN. Spontaneous or positional nystagmus is also commonly present in normal humans in
darkness [lo, 15, 161. The monkeys had no spontaneous
nystagmus when upright. For this reason, they were tested
only in the upright position.
T o test for pathways and structures responsible for neckafferent nystagmus, labyrinthine, cervical spinal cord, and
cerebellar lesions were made under anesthesia in the cat and
rabbit. The animals were tested over the next several weeks.
Thc extent of damage was determined in histological sections after sacrifice. The cerebellum was removed in 9
rabbits; labyrinthectomy and unilateral denervation of the
neck was done in 5 rabbits; and the dorsal half of the spinal
cord was destroyed just rostra1 to the entrance of the C1
dorsal roots i n 4 cats. After one labyrinth had been destroyed in 3 cats, a midline niyelotomy and unilateral deafferentation ofsegments C1 to C3 were done. The vertebral
neurovascular bundles were also interrupted in 1 cat [7 j.
Nelk-afferent Ataxia
CATS. Gait changes, a staggering type of ataxia, and
hypotonia were produced by about 80% (17 of 2 1) of
cervical injections of procaine in the cat. The animals
were more hypotonic and ataxic on the side of the
neck injection and had a tendency to fall toward this
side. They sought to support themselves by holding
the flank on the more hypotonic side against stable
MONKEYS. Ataxia after lateral neck infiltration was
even more striking in the monkey than in the cat. I t
was invariably more severe in the limbs on the side of
the neck block. Animals propped the more ataxic half
of the body against the walls of the cage and steadied
themselves by grasping the overhead bars with the
better-coordinated hand (Fig 2A). If disturbed, they
usually went to the rear of the cage and supported the
more ataxic half of the body while fending off intruding objects with the contralateral extremities. When
the animals were sitting up straight, the head and
trunk were tilted about 10 degrees toward the side of
the injection (Fig 2B). When the animals jumped, the
extremities on the side of the injection gave way, and
occasionally the monkeys fell to that side. Outward
past-pointing of the more ataxic forelimb was observed, but there was no intention tremor. Since hind
limbs were as much involved as forelimbs, the ataxic
signs were not due to leakage of lidocaine into the
brachial plexus. Five monkeys that received control
d e Jong et al: Neck-afferent Ataxla and Nystagmus
hypotonia on the injected side. After bilateral
neck injections, rabbits were unwilling to move and
had horizontal oscillating head movements. When
prodded vigorously, they made a few unsteady hops.
These signs disappeared within two hours.
SUMMARY. Ataxia was produced in cats, monkeys,
humans, and rabbits that received injections of local
anesthetics into one side of the neck. The humans
reported a strong sense of falling o r tilting. The symptoms and signs were more pronounced on the side of
injection and persisted for about an hour.
F i g 2. (A)Monkey shielding right hayof body ajier right
ceroical block with 2 % lidocaine. ( B , Deciation ofthe body
axis toward the side of rrrz,iral block o n the right.
injections of lidocaine into the thigh or saline into the
neck did not have ataxia.
O n e of the authors (J. d e Jong), a normal adult
male, had a cervical injection on two occasions. Immediately after each injection he experienced lightheadedness and an empty feeling in the hypochondrium. Shortly thereafter he had a strong sensation
that h e was being drawn toward the injected side "like
a bar of iron by a strong magnet." This occurred o n
both occasions. There was a positive plumb-line
Romberg sign, with deviation and past-pointing toward the injected side. He had n o dysarthria, intention tremor, dysmetria, dysdiadochokinesia, or disturbance in kinesthesia. When supine, he initially had
a sensation that the couch was slowly toppling over
toward the side of injection. Later, the sensation of
turning disappeared, and he felt tilted about 30 degrees from the horizontal. The sensation of tilt slowly
decreased over the next hour, and the ataxia gradually
subsided. For the remainder of the day he felt slight
unsteadiness of gait after sudden head movements.
A 47-year-old patient with hereditary posterior
root and column disease and severe sensory ataxia of
the limbs was injected o n one side of the neck. He
became dizzy and pale and sweated after injection. H e
also experienced a sensation of being drawn to the
side of injection, as had the author. Ten minutes after
injection the feeling that the couch was falling on its
side was so strong when his eyes were closed that he
tightly grasped one of the investigators. The patient's
symptoms lasted for about one hour. H e later died,
and the diagnosis was confirmed at autopsy [171.
Neck-afJerent Nystagmus
CATS. Nystagmus was induced in each of 27 cats after
about 35yh (27 of 77) of neck injections. The nystagmus was initially vigorous, reaching maximum frequencies of 3 beats per second (Fig 3A). It lasted from
four minutes to an hour (Fig 3B). The nystagmus was
predominantly horizontal and was not related to the
side of injection. As in the rabbit [ 7 ] , experiments
were performed to determine if the nystagmus had
been produced by changes in vertebral-basilar blood
flow. The vertebral arteries, veins, and plexus were
surgically destroyed in 1 cat. Nystagmus lasting up to
half an hour was induced by 5 of 7 neck injections over
the next week,
Neck-afferent nystagmus was induced in
the monkey only when lidocaine was injected against
the lateral side of the occipital condyle (see Fig 1). It
was not produced by injection at lower cervical levels.
F i g 3. Nystagmus in a rat (A,B)and rabbit /D,Ei affer
nerk injertion. The rabbit had hadapreiioza ierebellrrtomy.
I t s eye mowrrient.i before injection are shown in C . Upper
trare is horizontal EOG; lover traiz, imertiral EOG. Trare
dejfection.i. u p itidirate eye moi8enzezt.r t o the right and trpt
reJpectiwJy. Calibration beloti' E is N O p a r ~ d .rerods
the E0G.r.
A ww"wJ'*@~o/
c ---
rJf v l b
BRABBITS. Unilateral neck injection was followed
first by falling and rolling to the side of the injection,
then by lateropulsion, finally by transient hemi-
Annals of Neurology Vol 1 No 3 March 1977
2 sec
T h e nystagmus developed after about 40% (17 of 40)
of neck injections and was present at least once in each
of the 7 monkeys tested. Induction in 7 consecutive
animals was statistically significant (p > 0.008). The
nystagmus started just after completion of the injection and lasted for one to five minutes. Samples of-the
neck-afferent nystagmus in 2 monkeys are shown in
Figure 4.The nystagmus was predominantly horizontal, with maximum frequencies of about 1 bear per
second (Fig 4 B ) . Maximum velocities of the slow
phases were about 45 degrees per second. The nystagmus was present only in darkness and disappeared
if the animals were allowed to fixate. The induced
nystagmus was not present behind Frenzel glasses. In
most instances there was no clear relationship between the side of injection and the direction of the
nystagmus. However, in 1 monkey, injection of the
left side of the neck produced nystagmus to the right
(Fig 4C), and on a separate occasion injection of the
right side induced nystagmus to the left (Fig 4D).
MAN. Human subjects had no nystagmus after neck
infiltration. However, as noted, the site of neck injection was lower in man than in monkeys.
RABBITS. As previously reported [7], rabbits had
marked positional nystagmus lasting from 10 minutes
F i g 4 . Nystagmids inducrd by unilaterdneck iizjection i n a
monkey. Each trai-e i~ a horizorrtalE0G. (A)
Eye nzoiwzeizn
before in,jectiori i n hght and darkness. After left neck
injection (Bi there u'as nystagrnus t o the left In another
monkey. riystagnius t o theleft wa.i induucedaftera right neck
injection (Ci and t o the right after a left rrri-k injection
( D ) . Calibration oj' 10 degrees for eac-h qf the traces
is shown tzext t o C.
Before Injection
to two and one-half hours after a single lateral neck
injection. Neck-afferent nystagmus in a cerebellectomized rabbit (Fig 3D, E) was similar to that in the
intact rabbit.
SUMMARY. Neck-afferent nystagmus was produced
by neck injection in cats, monkeys, and rabbits. It
lasted longer in cats and rabbits than in monkeys and
was abolished in monkeys by fixation. I t was not observed in the human subjects.
Lubjrinthectomy and Neck-afferent Nystugmzls
In rabbits, neck-afferent nystagmus cannot be elicited
afrer bilateral labyrinthectomy [?] despite the preservation of strong cervical-ocular reflexes [ 171. This
implies that activity responsible for producing neckafferent nystagmus is mediated through the vestibular
system. Hikosaka and Maeda [ 181 investigated
oligosynaptic cervical-oculomotor pathways in the cat
using intracellular recordings. They showed that
pathways from the neck to abducens motoneurons
synapse in the vestibular nucleus, utilizing the vestibulooculomotor reflex arc. The interaction of cervical and labyrinthine afferents in inducing nystagmus
was studied in rabbits. O n e labyrinth was destroyed.
After recovery, neck-afferent nystagmus was readily
elicited by injection of either side of the neck. This
suggests that the activity from the neck responsible
for the nystagmus was mediated bilaterally. In 14 of
18 injections the nystagmus was more intense if the
side of the neck injection was up. This also indicates a
relationship of the nystagmus to head position and
gravity, ie, to the vestibular system.
The cervical roots were cut on one side in 5 animals
that had had a previous labyrinthectomy. Immediately
after neck dencrvation the rabbits fell to the side of
the labyrinthectomy and rolled about the body axis
(Fig 5A). The rolling toward the side of labyrinthecFzg j Reacttiation of rignr of a p e r . z o u i left
fabj rinthectonq after tectiou of ieri tial dona1 rooti C I t o
C 4 on either the rzght or the ldt side The aninialsjrst
exhrbrlcd roflzng tot( a d the J tde of 1abjrznthectorn1 ( A I ,
then turrizng ( B )
Lt Neck Injection
R t Neck Injection
Lt Neck Injection
de Jong et al: Neck-afferent Ataxia and Nystagmus 243
tomy was striking, and it happened regardless of the
side of neck denervation. Later the rabbits circled
toward the side of labyrinthectomy, mainly using the
forelimbs (Fig 5B). When the labyrinthectomy and
neck denervation were on the same side, the lateral
head position decreased from approximately 80 degrees to about 45 degrees over four to six weeks.
When the neck denervation was contralateral to the
side of labyrinthectomy, the angle of lateral head rotation did not change.
Postoperative nystagmus lasted for a month or
more in these animals. Subsequent injections of procaine into the upper neck muscles on the intact side
elicited positional nystagmus lasting up to 90 minutes
in 23 out of 26 trials. The direction of the nystagmus
was inconstant and could reverse during the same
trial. In contrast to animals with intact cervical roots,
neck-afferent nystagmus in animals after unilateral
rout section was generally as prominent with the intact
labyrinth up as down. When a preference did occur, it
was always with the labyrinth down.
Positional nystagmus was also produced by procaine infiltration in the neck of each of 4 cats after
unilateral labyrinthectorny (8 of 20 trials). Unlike the
rabbit, the cat showed no difference in the amount of
nystagmus in lateral positions, regardless of whether
the side of injection or the intact labyrinth was up or
Uptokinetic and Culoric Nystugmus and
Neck-ufferent Npstugmu
The possible influences of cervical anesthesia and
neck-afferent nystagmus on O K N and caloric nystagmus were investigated in 5 monkeys. Changes in
mean maximum slow-phase velocity and total deviation over 30-second periods were used as indices.
Despite the ataxia and transient nystagmus that
developed after lidocaine injection, there was no directional preponderance of O K N associated with unilateral neck injection, and O K A N was still present.
Similarly, caloric nystagmus was not greatly affected
by neck injection. A transient decline in maximum
velocity of the slow phases occurred. However, this
decline was also produced by lidocaine injections in
the thigh, and there was n o component of change that
could be directly attributed to the neck injection.
Centrul Pathumay Medzuting Neck-afferent
Nys tagrnui
Effects of cerebellectomy on neck-afferent nystagmus
were studied in the rabbit. After cerebellectomy in 9
animals, positional nystagmus or a significant increase
in postoperative nystagmus was produced by neck
injection in 13 out of 30 trials. An example is shown in
Figure 3D,E. At least 1 positive trial was obtained in
each of the 9 animals. Therefore, pathways responsi-
244 Annals of Neurology
Vol 1 No 3 March 1977
ble for neck-afferent nystagmus probably d o not go
primarily through the cerebellum.
Lorente de NO [IS] demonstrated that a transverse
brainstem lesion just caudal to the medial vestibular
nuclei selectively abolished tonic components of cervicoocular reflexes in the rabbit while preserving
phasic components. That is, in normal rabbits, when
the body was turned o n the head, the eyes moved to
the contralateral side and remained this way for as
long as the body-on-head tilt was maintained. After
the lesion the eyes still moved contralaterally but did
not hold the lateral position as before. Therefore, he
postulated a double cervicooculomotor pathway, ie,
direct and polysynaptic, as being most likely.
Oligosynaptic pathways from the neck to the abducens motoneurons ascend ipsilaterally in the cord,
crossing at a level between the obex and the rostral
end of the inferior olivary nucleus to synapse in the
medial vestibular nucleus [IS]. The location of multisynaptic pathways is not known.
In 4 cats the dorsal spinal cord was hemisected at C1
(Fig 6A). Postoperatively, nystagmus was striking and
persisted for six to eight weeks. Subsequently, nystagmus was elicited by one-third (17 of 50) of cervical
procaine infiltrations in these animals (Fig 6B). Therefore, pathways responsible for neck-afferent nystagmus probably lie in ventral portions of the cervical
cord. To determine whether o r not activity responsible for neck-afferent nystagmus decussated in the cervical cord, commissural fibers were interrupted b y
midline myelotomy between C1 and C 3 in 3 cats (Fig
6C). To avoid the effects of leakage of local anesthetic
across the midline of the neck, C1 to C3 were deafferented on one side. Neck-afferent positional nys-
tagmus was elicited in 10 out of 25 trials after
blockade of the neck receptors on the intact side (Fig
6D). These findings suggest that pathways responsible
for neck-afferent nystagmus ascend ipsilaterally.
Ataxia was produced in every species by injection of
local anesthetics into the neck muscles. O n each of 3
occasions when local anesthetics were given to humans, the injections induced vertigo, manifested by a
sense of tilting or falling. Presumably the local anesthetics affected the afferent activity of the neck muscle receptors. These and previous results [20] suggest
that ataxia, dizziness, and vertigo can arise from disorders affecting the afferent flow of impulses from deep
tissues of the neck. Since the effects of neck injection
presumably were mediated through the vestibular
nuclei, it might be difficult in many circumstances to
differentiate neck-afferent ataxia and vertigo from the
ataxia and vertigo produced by lesions of the vestibular system. In this regard, it was of interest that a
strong sensation of dizziness and vertigo was present
in both human subjects without there being any nystagmus. Most commonly after vestibular system lesions, nystagmus is present.
I t would seem that the ataxia induced by altering the
afferent inffow from cervical receptors on one side has
now been studied sufficiently to warrant a description
of its properties. Unilateral neck anesthesia in every
species, including humans [7, 2 0 , 2 11, has apredominantly ipsilateral effect and is followed by ataxia,
past-pointing, hypotonia, and unwillingness to move.
Intention tremor and dysarthria have never been
noted. Past-pointing and missing of objects with the
hand are striking, but there is no definite dysnietria of
finger movement. Kinesthesia of the limbs is not impaired. Consistent with these findings is the old observation that in some instances ataxia is relieved by
wearing a neck collar [ 1, 31. Similar results have been
reported in patients with whiplash injuries [ 2 2 ] .
There is not enough information to know the clinical effects of bilateral alteration of the afferent inflow
from cervical receptors in humans. However, in primates and other animals, lesions of the muscles on
both sides of the neck or bilateral neck injections are
followed by a broad-based, staggering gait, as if the
animals were drunk [ 1-41. If the neck muscles in the
finch are cut bilaterally, the bird cannot fly, though it
can walk and hop [ 2 ] .In the monkey, head tremor is
often present after neck injection [4].
The same symptoms may not be present in the cat and monkey after
cervical root section, however ([5] and Cohen B: unpublished results, 1969). Presumably, complete absence of cervical sensation may have a different effect
than does transient alteration of sensation.
Neck-afferent hTystugmu.r
The ability of the neck to induce nystagmus appeared
to be species-dependent in that the nystagmus was
stronger and lasted longer in the cat and rabbit than in
the monkey. In primates the oculomotor effects of
cervical anesthesia were transient and were not associated with directional preponderance of either
caloric nystagmus or OKN. Nystagmus was not induced in humans after neck injections. This may be
related to a species difference or to the site of injection, since in the human subjects the lidocaine was
deposited in the lower part of the neck at the C3 to C4
level. Later, it was shown that to obtain nystagmus in
the monkey it was necessary to inject lidocaine close
to the occipital condyle at the level of C1, but subsequent injections at the C1 level were not done in
l n monkeys, as in cats [201, nystagmus induced by
neck injection was predominantly horizontal and was
present in the upright position. Horizontal nystagmus
after neck injection has also been found in man on
positional testing [ 8 , 9 ] .In the rabbit, both horizontal
and vertical positional nystagmus were induced by
dorsal root section 17, 201.
Studies on eye movements induced by cervical
root, muscle, and joint stimulation provide a basis for
these effects. In most species, horizontal eye
movements are induced by dorsal root stimulation
[23] or by head-on-neck movement [24].Dichgans et
a1 [25] found ocular deviations induced by head
movement to be weak in the intact monkey. However,
after labyrinthectomy, cervicooculomotor pathways
became much more potent, and compensatory eye
movements during head movements were then based
primarily on sensations that originated in the cervical
muscle and joint receptors.
This conversion of a latent to an overt mechanism
after labyrinthectomy implies that under some circumstances cervical abnormalities are responsible for
causing disorders of equilibrium and possibly nystagmus, although nystagmus after dorsal root ablation or
neck blockade in intact animals is weak. That is, subsequent pathological involvement of the deep tissues
of the neck after labyrinthine damage might result in
symptoms that had not occurred before. The recurrence of ataxia and nystagmus in the labyrinthectomized rabbit after unilateral dorsal root section
seems relevant in this regard. Investigators pursuing
future studies o f the effects of cervical lesions on body
postural or oculomotor systems may find it useful to
consider whether or not lesions of the vestibular system had antedated the cervical lesions.
Several interesting points were raised by the CNS
lesions. A finding of clinical interest was that persistent nystagmus was produced by hemisection of the
dorsal cord at C1. These data appear to be another
de Jong et al: Neck-afferent Ataxia and Nystagrnus
confirmation of the existence of cervicooculomotor
pathways. The lesion studies add the new information
that the cervicooculomotor pathways are not interrupted by cerebellectomy, and, in agreement with
Hikosakaand Maeda's [18]findings, they show that, at
least in part, the pathways ascend ipsilaterally through
the ventral regions of the cord.
Supported by N A T O and by N I N C D S Research Grant N S 00294.
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local, ataxia, anesthetic, induced, injections, neck, nystagmus
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