Clinical Correlation Between Vertical Gaze Palsy and Midbrain Volume in Progressive Supranuclear Palsy

Background and PurposeDoes gaze control influence lower-extremity motor coordination in people with neurological deficits? The purpose of this study was to determine whether foot kinematics during stair climbing are influenced by gaze shifts prior to stair step initiation.Subjects and MethodsTwelve subjects with gaze palsy (mild versus severe) secondary to progressive supranuclear palsy were evaluated during a stair-climbing task in a cross-sectional study of mechanisms influencing eye-foot coordination. Infrared oculography and electromagnetic tracking sensors measured eye and foot kinematics, respectively. The primary outcome measures were vertical gaze fixation scores, foot lift asymmetries, and sagittal-plane foot trajectories.ResultsThe subjects with severe gaze palsy had significantly lower lag foot lift relative to lead foot lift than those with a mild form of gaze palsy. The lag foot trajectory for the subjects with severe gaze palsy tended to be low, with a heading toward contact with the edge of the stair. Subjects with severe gaze palsy were 28 times more likely to experience “fixation intrusion” (high vertical gaze fixation score) during an attempted shift of gaze downward than those with mild ocular motor deficits (odds ratio [OR]=28.3, 95% confidence interval [CI]=6.4–124.8). Subjects with severe gaze shift deficits also were 4 times more likely to have lower lag foot lift with respect to lead foot lift than those with mild ocular motor dysfunction (OR=4.0, 95% CI=1.7–9.7).Discussion and ConclusionThe small number of subjects and the variation in symptom profiles make the generalization of findings preliminary. Deficits in gaze control may influence stepping behaviors and increase the risk of trips or falls during stair climbing. Neural and kinematic hypotheses are discussed as possible contributing mechanisms.

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A Case of Early onset Vertical Gaze Palsy with Bipolar Disorder

Bengal Journal of Psychiatry ◽

10.51332/bjp.2018.v23.i1.91 ◽

2018 ◽

pp. 16-19

Author(s):

Ranjan Bhattacharyya ◽

Shubho Chowdhuri

Keyword(s):

Bipolar Disorder ◽

Cognitive Impairment ◽

Progressive Supranuclear Palsy ◽

Movement Disorder ◽

Key Words ◽

Early Onset ◽

Clinical Case ◽

Pathological Laughter ◽

Vertical Gaze ◽

Gaze Palsy

A lady with early onset cognitive impairment with movement disorder and elevated mood, grandiosity, distractibility, flight of ideas, pressure of speech presented in outpatient department and initially diagnosed as Bipolar disorder with early onset parkinsonism and Frontotemporal dementia. She later developed vertical gaze palsy with slow saccadic movements and her diagnosis was confirmed as Progressive supranuclear palsy (PSP). The association of bipolar disorder indigenous to pathological laughter and crying is the pearl of this clinical case. Key words : PSP, Bipolar disorder, vertical gaze palsy, extrapyramidal symptoms

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