Different types of skew deviation.

Although all manifest skew deviations appear the same for the clinician, skew deviation can result from different combinations of dysconjugate vertical ocular deviations. Evidence is presented for three different types of skew deviation when it occurs as a feature of an ocular tilt reaction. In type 1 (utricle) there is upward deviation of both eyes with different amplitudes, as described for otolith Tullio phenomenon in humans. In Type 2 (dorsolateral medulla oblongata) hypertropia of one eye occurs while the other eye remains in the primary position, the hypothetical mechanism of skew deviation in Wallenberg's syndrome. In Type 3 (midbrain tegmentum) there is simultaneous hypertropia of one eye and hypotropia of the other eye, as described for electrical stimulation of midbrain tegmentum in monkeys and observed in clinical cases with a paroxysmal ocular tilt reaction.

Visual postural performance after loss of somatosensory and vestibular function.

Visual stabilisation of body sway in a patient with severe deficits of the vestibular system (due to gentamicin treatment) and the somatosensory system (due to polyneuropathy) was studied. With eyes open the patient was able to stand and walk slowly. With eyes closed he lost balance within one second. In order to optimise visual stabilisation he intuitively searched for nearby visual targets. His postural sway was recorded using posturography. His balance performance deteriorated significantly beyond a distance of 1 m between the eyes and the surrounding objects and with visual acuity below 0.3 (experimentally achieved with semitransparent plastic foils). With flicker illumination of decreasing frequencies of the visual surround he needed at least a visual input rate of 17 Hz in order to maintain an upright body position. The data provide clinical evidence for rapid visuo-spinal control of posture.

The European vestibular experiments in Spacelab-1.

A series of experiments were performed in the Spacelab-1 mission on November/December, 1983, pre-, in-, and postflight. These experiments covered various aspects of the functions of the vestibular system, the inflight tests comprising threshold measurements for linear movements in three orthogonal axes, optokinetic stimulation, vestibulo-ocular reflexes under linear and angular accelerations, caloric stimulation with and without linear accelerations; pre- and postflight tests repeated the inflight protocol with the addition of subjective vertical and eye counter-rotation measurements using a tilt table. One of the most surprising and significant results was the caloric test: strong caloric nystagmus on the two subjects tested was recorded inflight; this was contrary to what was expected from Barany's convection hypothesis for caloric nystagmus.