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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.

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SUPRANUCLEAR DISORDERS OF EYE MOVEMENT

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  1. 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

  2. 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

  3. ‘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

  4. 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

  5. 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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