In:
Spektrum der Augenheilkunde, Springer Science and Business Media LLC, Vol. 35, No. 1 ( 2021-02), p. 36-43
Abstract:
Vertical gaze palsy (vGP) is a typical symptom in lesions of the dorsal midbrain. The clinical picture of vGP is variable and can be part of a dorsal midbrain syndrome (DMS) in combination with additional symptoms including convergence paresis, convergence-retraction nystagmus, disturbed pupil reaction or skew deviation. Depending on the size and site of the lesion other central oculomotor disorders can also be present. Material and methods The patient files of the neuro-ophthalmology clinic over a period of 25 years were reviewed for cases with conjugated vertical oculomotor disorders. The records were retrospectively analyzed concerning the neuro-orthoptic findings and etiologies. Results A total of 202 patients with vGP were identified. There was a continuous spectrum of findings from isolated paresis of upward saccades to a complete loss of all voluntary and reflectory vertical eye movements. Only 12 vGP were clinically isolated. There were 155 patients with a DMS but only 18 corresponded to the clinical picture as characterized by Parinaud (vGP + convergence paresis ± pupil disturbance without further symptoms). Of the patients with DMS 42 showed only a paresis of vertical saccades. In DMS the upgaze was generally more impaired than the downgaze. The most frequently associated symptoms were convergence paresis (49%), convergence nystagmus (40%), pupil disturbance (32%), skew deviation (21%) and gaze-evoked nystagmus (15%). A total of 58 cases had further central oculomotor disorders. In patients up to 18 years of age vGP was caused by cerebral tumors in 58%, whereas above the age of 60 years degenerative diseases (44%) and DMS after infarcts (41%) were the predominant causes. Conclusion Slow and fast eye movements of upgaze and downgaze are differently generated, conducted and integrated into the brainstem and can be variably affected in midbrain lesions. The findings also illustrate the proximity of centers responsible for vertical eye movements, convergence and pupil reaction in the dorsal midbrain. The combination of a vGP with other neuro-ophthalmologic diagnoses can therefore help in topographical and etiological allocation.
Type of Medium:
Online Resource
ISSN:
0930-4282
,
1613-7523
DOI:
10.1007/s00717-021-00482-w
Language:
German
Publisher:
Springer Science and Business Media LLC
Publication Date:
2021
detail.hit.zdb_id:
2010368-2
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