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SUPRANUCLEAR DISORDERS OF EYE MOVEMENT

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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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slide1

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
slide2

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
slide3

‘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
slide4

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
slide5

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