Profile of Gaze Dysfunction following Cerebrovascular Accident

Aim. To evaluate the profile of ocular gaze abnormalities occurring following stroke. Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol including assessment of visual acuity, ocular alignment and motility, visual field, and visual perception. Results. 915 patients recruited: mean age 69.18 years (SD 14.19). 498 patients (54%) were diagnosed with ocular motility abnormalities. 207 patients had gaze abnormalities including impaired gaze holding (46), complete gaze palsy (23), horizontal gaze palsy (16), vertical gaze palsy (17), Parinaud’s syndrome (8), INO (20), one and half syndrome (3), saccadic palsy (28), and smooth pursuit palsy (46). These were isolated impairments in 50% of cases and in association with other ocular abnormalities in 50% including impaired convergence, nystagmus, and lid or pupil abnormalities. Areas of brain stroke were frequently the cerebellum, brainstem, and diencephalic areas. Strokes causing gaze dysfunction also involved cortical areas including occipital, parietal, and temporal lobes. Symptoms of diplopia and blurred vision were present in 35%. 37 patients were discharged, 29 referred, and 141 offered review appointments. 107 reviewed patients showed full recovery (4%), partial improvement (66%), and static gaze dysfunction (30%). Conclusions. Gaze dysfunction is common following stroke. Approximately one-third of patients complain of visual symptoms, two thirds show some improvement in ocular motility.

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Lithium-Induced Downbeat Nystagmus and Horizontal Gaze Palsy

The Open Ophthalmology Journal ◽

10.2174/1874364101610010126 ◽

2016 ◽

Vol 10 (1) ◽

pp. 126-128 ◽

Cited By ~ 8

Author(s):

Jesper Skovlund Jørgensen ◽

Lisbeth Landschoff Lassen ◽

Marianne Wegener

Keyword(s):

Affective Disorder ◽

Therapeutic Range ◽

Bipolar Affective Disorder ◽

Lithium Carbonate ◽

Downbeat Nystagmus ◽

Ocular Motility ◽

Horizontal Gaze ◽

Gaze Palsy

We report a case of lithium-induced downbeat nystagmus and horizontal gaze palsy in a 62-year-old woman who was treated for a bipolar affective disorder with lithium carbonate for one month. At presentation serum lithium was within therapeutic range. No alternative causes of the ocular motility disturbances were found, and the patient improved significantly as lithium carbonate was discontinued.

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Disorders of Ocular Motility Due to Disease of the Brainstem, Cerebellum, and Diencephalon

The Neurology of Eye Movements ◽

10.1093/med/9780199969289.003.0013 ◽

2015 ◽

pp. 836-915

Author(s):

R. John Leigh ◽

David S. Zee

Keyword(s):

Developmental Disorders ◽

Medial Longitudinal Fasciculus ◽

Ocular Motility ◽

Posterior Commissure ◽

Interstitial Nucleus Of Cajal ◽

Abducens Nucleus ◽

Cerebellar Syndromes ◽

Vertical Gaze ◽

Dorsal Midbrain Syndrome ◽

Gaze Palsy

This chapter reviews clinical features (with illustrative video cases) and pathophysiology of medullary lesions, including Wallenberg’s syndrome and oculopalatal tremor. Manifestations and pathophysiology of three cerebellar syndromes are described (flocculus and paraflocculus, nodulus and ventral uvula, dorsal vermis and fastigial nucleus), applying these principles to interpret the effects of developmental disorders (e.g., Chiari malformation), hereditary ataxia, paraneoplastic cerebellar degeneration, cerebellar stroke, and cerebellar tumors. Characteristics of pontine lesions are discussed, including lesions of the abducens nucleus, paramedian pontine reticular formation (PPRF), internuclear ophthalmoplegia (INO), one-and-a-half syndrome, slow horizontal saccades, and saccadic oscillations. The effects of midbrain lesions are summarized, including lesions affecting the rostral interstitial nucleus of the medial longitudinal fasciculus (RIMLF), interstitial nucleus of Cajal, posterior commissure, and more diffuse processes causing slow vertical saccades or vertical gaze palsy (dorsal midbrain syndrome), including Whipple’s disease. Effects of lesions affecting the superior colliculus, thalamus, and pulvinar are also discussed.

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Isolated bilateral horizontal gaze palsy as first manifestation of multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458513518627 ◽

2014 ◽

Vol 20 (6) ◽

pp. 754-755 ◽

Cited By ~ 9

Author(s):

Stefan Kipfer ◽

David W Crook

Keyword(s):

Multiple Sclerosis ◽

Brain Magnetic Resonance Imaging ◽

Sudden Onset ◽

Neurological Deficits ◽

Medial Part ◽

Blurred Vision ◽

Initial Manifestation ◽

Pontine Tegmentum ◽

Horizontal Gaze ◽

Gaze Palsy

Predilection sites for infratentorial multiple sclerosis lesions are well known and frequently involve the fasciculus longitudinalis medialis leading to classical internuclear ophthalmoplegia. We report a very rare oculomotor disorder due to a demyelinating central nervous system (CNS) lesion in the medial part of the lower pontine tegmentum. A 36-year-old man presented with sudden onset of blurred vision. Clinically there was limited eye adduction and abduction to either side, which corresponds to bilateral horizontal gaze palsy. Brain magnetic resonance imaging (MRI) showed a demyelinating CNS lesion affecting the fasciculus longitudinalis medialis, abducens nuclei or abducens fibres in the medial part of the lower pontine tegmentum. Furthermore there were six further demyelinating white matter lesions fulfilling all Barkhof criteria for multiple sclerosis. Demyelinating CNS lesions causing isolated bilateral horizontal gaze palsy are exceptional and usually associated with further focal neurological deficits, which was not the case in the presenting patient. This is a unique video report of isolated bilateral horizontal gaze palsy as the initial manifestation of demyelinating CNS disease, which lead to definite diagnosis of relapsing remitting multiple sclerosis.

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Wall-eyed bilateral internuclear ophthalmoplegia in posterior circulation stroke-a case report

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20214141 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1752

Author(s):

Mary Stephen A. ◽

Jayasri P. ◽

Harigaravelu P. J.

Keyword(s):

Case Report ◽

Neurological Impairment ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Medial Longitudinal Fasciculus ◽

Ocular Motility ◽

Internuclear Ophthalmoplegia ◽

Headache Patient ◽

Vertical Gaze ◽

Gaze Palsy

Internuclear ophthalmoplegia is characterised by restricted ocular motility in lateral gaze in which the affected eye shows impairment of adduction and it results from damage to medial longitudinal fasciculus (MLF). Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is an extremely rare neurological manifestation which has typical signs including primary gaze exotropia, vertical gaze palsy, ptosis, abducting nystagmus. The common and serious etiological factor is cerebrovascular accident involving the vessels supplying MLF and many cases have life threatening associated neurological impairment. In this case report we have discussed about a gentleman who presented with bilateral ptosis, primary gaze exotropia and headache. Patient found to have vertical gaze palsy and abducting nystagmus on examination. Computed tomography (CT) imaging shows infarct in pontine region and CT angiography revealed basilar artery occlusion supplying region of pons with involvement of posterior cerebral artery. Patient treated with antiplatelet and diplopia managed. Patient showed improvement on subsequent follow-up visits.

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