The Internuclear Ophthalmoplegias

Internuclear ophthalmoplegia (INO), which is caused by an ipsilateral medial longitudinal fasciculus (MLF) lesion, is characterized by adduction paresis of lateral gaze, usually with spared convergence [1–4]. In the opposite eye, abduction nystagmus and hypermetric abduction saccades are the main clinical and electro-oculographic abnormalities [1, 5, 6]. The origin of both is still debated. Abduction nystagmus has been explained by (a) an additional horizontal gaze paresis [7]; (b) vergence mechanisms aimed at alignment of the visual axes [8]; (c) interruption of descending excitatory projections from oculomotor nucleus internuclear neurons to contralateral abducens nucleus motoneurons [9];…