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SUPRANUCLEAR DISORDERS OF EYE MOVEMENT. 1. Horizontal gaze palsies. Internuclear ophthalmoplegia Combined internuclear and PPRF (‘one-and-a-half syndrome’). MLF. 2. Vertical gaze palsies. Parinaud dorsal midbrain syndrome Progressive supranuclear palsy.

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SUPRANUCLEAR DISORDERS OF

EYE MOVEMENT

1. Horizontal gaze palsies

  • Internuclear ophthalmoplegia

  • Combined internuclear and PPRF

  • (‘one-and-a-half syndrome’)

MLF

2. Vertical gaze palsies

  • Parinaud dorsal midbrain syndrome

  • Progressive supranuclear palsy


Internuclear ophthalmoplegia

Lesion involving left MLF

Normal left gaze

Defective left adduction and ataxic

nystagmus of right eye

Convergence intact if lesion discrete

Important causes

  • Demylination - usually bilateral

  • Vascular disease

  • Tumours of brainstem


‘One-and-a-half syndrome ’

Combined lesion of left MLF and PPRF

  • Defective left adduction

  • Ipsilateral (left) gaze palsy

  • Normal right abduction with ataxic

  • nystagmus


Parinaud dorsal midbrain syndrome

  • Supranuclear upgaze palsy

  • Normal downgaze

  • Large pupils with light-near dissociation

  • Convergence weakness

  • Lid retracton (Collier sign)

  • Convergence-retraction nystagmus

Important causes

  • In children: aqueduct stenosis, meningitis and pinealoma

  • In young adults: demylination, trauma and a-v malformations

  • In elderly: vascular accidents and posterior fossa aneurysms


Progressive supranuclear palsy

( Steele-Richardson-Olszewski syndrome )

  • Affects elderly

  • Pseudobulbar palsy

Initially involves downgaze

  • Extrapyramidal rigidity

  • Gait ataxia

  • Dementia

Subsequent defective up and

horizontal gaze


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