Citation

Rucker JC, Buettner-Ennever J, Straumann D, Cohen B. J. Neurophysiol. 2019; ePub(ePub): ePub.

Affiliation

Icahn School of Medicine at Mount Sinai, United States.

Copyright

(Copyright © 2019, American Physiological Society)

DOI

10.1152/jn.00861.2018

PMID

31339793

Abstract

Deficits of convergence and accommodation are common following traumatic brain injury, including mild traumatic brain injury, though the mechanism and localization of these deficits have been unclear and supranuclear control of the near-vision response has been incompletely understood. We describe a patient who developed profound instability of the near-vision response with inability to maintain convergence and accommodation following mild traumatic brain injury, who was identified to have a structural lesion on brain MRI in the pulvinar of the caudal thalamus, the pretectum, and the rostral superior colliculus (SC). We discuss the potential relationship between post-traumatic clinical near-vision response deficits and the MRI lesion in this patient. We further propose that the MRI lesion location, specifically the rostral superior colliculus, participates in neural integration for convergence holding, given its proven anatomic connections with the central mesencephalic reticular formation (cMRF) and C-group medial rectus motoneurons in the oculomotor nucleus which project to extraocular muscle non-twitch fibers specialized for fatigue-resistant, slow, tonic activity such as vergence holding.

Language: en

Keywords

concussion; convergence; near response; pretectum; superior colliculus