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NEUROLOGY 2008;70:e57-e67
© 2008 American Academy of Neurology
Resident and Fellow Section

Pearls & Oy-sters: The medial longitudinal fasciculus in ocular motor physiology

T. C. Frohman, BA, S. Galetta, MD, R. Fox, MD, D. Solomon, MD, PhD, D. Straumann, MD, M. Filippi, MD, D. Zee, MD and E. M. Frohman, MD, PhD

From the Departments of Neurology (T.C.F., E.M.F.) and Ophthalmology (E.M.F.), University of Texas Southwestern Medical Center at Dallas; Department of Neurology, University of Pennsylvania (S.G.), Philadelphia; Mellen Center for Multiple Sclerosis (R.F.), Department of Neurology, Cleveland Clinic, OH; Department of Neurology (D. Solomon, D.Z.), The Johns Hopkins Hospital, Baltimore, MD; Department of Neurology (D. Straumann), Zurich University Hospital, Switzerland; and Department of Neurology (M.F.), Scientific Institute, Neuroimaging Research Unit, University Ospedale San Raffaele, Milan, Italy.

Address correspondence and reprint requests to Dr. Elliot M. Frohman, Department of Neurology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX75235

Objective: To review the role played by the medial longitudinal fasciculus (MLF) in ocular motor physiology and to characterize a number of syndromes that result from lesions in this eloquent brainstem tract system.

Background: The MLF is responsible for transmitting information that is crucial for the coordination and synchronization of all major classes of eye movements. A number of disease processes can produce lesions within this small yet highly strategic white matter pathway resulting in a myriad of neuro-ophthalmologic signs and symptoms.

Methods: We carefully reviewed both the literature and our collective experiences to systematically consider the neuroanatomy and physiology of the MLF and the pathophysiologic mechanisms that underlie syndromes deriving from lesions in this pathway.

Results: The MLF is an important structure and is composed of numerous projection systems involved in the regulation of eye movements. Pathology at this location can produce a constellation of abnormalities, many of which can be identified upon careful bedside neurologic examination.

Conclusion: This review of the medial longitudinal fasciculus and its constituent pathways is germane to understanding a number of important principles in neuro-ophthalmology.

GLOSSARY: FEF = frontal eye field; FPA = first-pass amplitude; INC = interstitial nucleus of Cajal; INO = internuclear ophthalmoparesis; MLF = medial longitudinal fasciculus; MS = multiple sclerosis; NPH = nucleus prepositus hypoglossi; NRTP = nucleus reticularis tegmenti pontis; OD = right eye; OS = left eye; OTR = ocular tilt reaction; PPRF = paramedian pontine reticular formation; PSP = progressive supranuclear palsy; r-VOR = rotational vestibular ocular reflex; riMLF = rostral interstitial nucleus of the MLF; SC = superior colliculus; SVN = superior vestibular nucleus; VDI = versional disconjugacy index; VLVN = ventral lateral vestibular nucleus.

elliot.frohman{at}utsouthwestern.edu

Supported by the National Multiple Sclerosis Society (Lone Star Chapter), the "Once Upon A Time," the Cain/Denius Comprehensive Center for Mobility Research, the Irene Wadel and Robert Atha fund, the Kenney Marie Dixon Pickens fund, and the Jean Ann and Steve Brock Fund for Medical Sciences.

Disclosure: Teresa Frohman has no conflicts to declare. Steven Galetta has received lecture fees from Biogen Idec. Dr. Fox has received grant or research support from Biogen Idec, Genentech, Merck, National Institutes of Health, and National MS Society. Bob Fox has served as a consultant for Biogen Idec, Genentech, Merck, Questcor, and Teva Neuroscience. David Solomon has no conflicts to declare. Dominik Straumann has no conflicts to declare. Massimo Filippi has received grants/contracts and honoraria/consultation fees from TEVA Neuroscience, Dompè Biogen, Bayer-Shering, and Merck-Serono. David Zee has no conflicts to declare. Elliot Frohman has received lecture fees from Biogen Idec, TEVA, and Serono and consulting fees from Biogen Idec.




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