Disorders Of Gaze

VERTICAL GAZE PALSY

Midbrain or pontine lesions may produce failure of upward or downward gaze. Disturbed downward gaze alone occurs with periaqueductal (Sylvian aqueduct) lesions. Impaired vertical eye movement is common in extrapyramidal disease (Progressive supranuclear palsy, page 357).

PARINAUD'S SYNDROME

This syndrome is characterised by impaired upward eye movements in association with a dorsal midbrain lesion ( + )•

Pineal gland

Superior colliculus ~ —

Inferior colliculus

Corpus callosum ventricle

Corpus callosum ventricle

- upward gaze and convergence are lost

- the pupils may dilate and the response to light and accommodation is impaired

Causes:

Third ventricular tumours Multiple sclerosis

Pineal region tumours Wernicke's encephalopathy

Hydrocephalus Encephalitis

INTERNUCLEAR OPHTHALMOPLEGIA (ataxic nystagmus)

This disorder, caused by damage to the medial longitudinal bundle, is dealt with on page 182. It is an internuclear disorder of eye movement and produces a disconjugate gaze palsy.

Two unusual disconjugate gaze palsies are -

Webino syndrome (wall eyes - bilateral internuclear ophthalmoplegia): characterised by bilateral exotropia and loss of convergence

The 'One and a half syndrome: Conjugate gaze palsy to one side and '¡Look leil>

impaired adduction on looking to the other side

OCULAR APRAXIA

Bilateral prefrontal motor cortex damage will produce this unusual finding in which the patient does not move the eyes voluntarily to command, yet has a full range of random eye movement. 153

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