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Investigations into the anatomical location, physiological function, clinical implications, and significance of the nucleus of Perlia

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Abstract

Background

The article discusses the investigations into the nucleus of Perlia (NP), a spindle-shaped nucleus located in the dorsal aspect of the oculomotor complex. However, there is still debate over its exact location and function, with conflicting findings in nonhuman primates. Therefore, the current study aimed the describe the location, function, clinical and surgical implications of NP.

Methods

A systematic review was conducted to identify studies related to the following MeSH terms: “perlia nucleus” OR “nucleus of “perlia” OR “convergence nucleus” OR “nucleus of convergence” OR “Perlia’s nucleus”. The search was conducted until September 2022.

Results

The location of the NP has been consistently reported in various studies, with most describing it as situated ventral to the Edinger–Westphal nucleus (EW) and dorsomedial to the oculomotor complex. The incidence of the NP in humans has been reported to range from 9 to 40%. In primates, it was observed to be absent in 77% of midbrains, while well developed in 9%. It is also noted that the NP is not a single nucleus, but rather a group of nuclei that are interconnected and involved in the coordination of eye movements that contain parasympathetic neurons.

Conclusions

The study of the NP holds clinical implications for understanding the neural mechanisms underlying the irregularities in the pupillary light reflex, such as anisocoria or abnormal responses to light, diagnosis, and treatment of neurological disorders like Horner’s syndrome, and management of eye movement disorders including one-and-a-half syndrome, vertical gaze palsy, skew deviation and ptosis. The current study also highlighted the limitations of previous studies, including variations in the reported prevalence of the NP, limitations of the histological techniques, and inconsistent findings across human and animal studies.

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Data availability

Data and materials are available for review upon request.

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Acknowledgements

The present study was presented at the 2nd International Hippocrates Congress on Medical and Health Sciences, which took place from the 28th to the 30th of June in 2019.

Funding

The study has no financial or personal relationship with any third party whose interests could be influenced positively or negatively by the article’s content. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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  1. Faculty of Medicine, Department of Anatomy, Istanbul Medeniyet University, 34700, Istanbul, Türkiye

    Eren Ogut

  2. Faculty of Medicine, Medical Faculty Student, Bahçeşehir University, 34734, Istanbul, Türkiye

    Pamirhan Kaya, Ozge Karakas, Edanur Yildiz & Ilgin Sozge

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EO: supervision, project development, data collection, illustration of figures, and manuscript writing. PK: data collection and manuscript writing. OK: data collection and manuscript writing. EY: data collection and manuscript writing. IS: data collection and manuscript writing. The authors described their own experience and all authors read and approved the final manuscript.

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Correspondence to Eren Ogut.

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Ogut, E., Kaya, P., Karakas, O. et al. Investigations into the anatomical location, physiological function, clinical implications, and significance of the nucleus of Perlia. Acta Neurol Belg (2024). https://doi.org/10.1007/s13760-024-02533-w

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