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

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.