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Fig. 2 | Journal of Clinical Movement Disorders

Fig. 2

From: The diagnostic value of saccades in movement disorder patients: a practical guide and review

Fig. 2

Anatomical substrates for vertical and horizontal saccades. This picture illustrates the brainstem excitatory burst neurons and neural integrators for horizontal and vertical saccades, as well as examples of disorders affecting these structures. For horizontal saccades, excitatory burst neurons are located in the paramedian pontine reticular formation (PPRF) in the pons. The medial vestibular nucleus/nucleus prepositus hypoglossi (MVN/NPH) in the medulla are the horizontal neural integrators. For vertical saccades, excitatory burst neurons are predominantly located in the rostral interstitial nucleus of the medial longitudinal fasciculus (RIMLF), and the interstitial nucleus of Cajal (INC) is the vertical neural integrator. Both of these are in the midbrain. The nucleus raphe interpositus (RIP) in the pons houses the omnipause neurons. *Lesion may not be direct lesion of the MVN/NPH, but may be lesion of the cerebellar feedback circuitry to these structures. Abbreviations: PSP, progressive supranuclear palsy; NPC, Niemann-Pick type C; SCA2, spinocerebellar ataxia type 2; OMAS, opsoclonus-myoclonus ataxia syndrome; MSA, multiple system atrophy; RIMLF, rostral interstitial nucleus of the medial longitudial fasciculus; INC, interstitial nucleus of Cajal; PPRF, paramedian pontine reticular formation; RIP, nucleus raphe interpositus; MVN/NPH, medial vestibular nucleus/nucleus prepositus hypoglossi

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