SUPRANUCLEAR DISORDERS OF
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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

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Supranuclear disorders of eye movement

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


Supranuclear disorders of eye movement

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


Supranuclear disorders of eye movement

‘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


Supranuclear disorders of eye movement

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


Supranuclear disorders of eye movement

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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