Share to: share facebook share twitter share wa share telegram print page

Conjugate gaze palsy

Conjugate gaze palsy
SpecialtyNeurology

Conjugate gaze palsies are neurological disorders affecting the ability to move both eyes in the same direction. These palsies can affect gaze in a horizontal, upward, or downward direction.[1] These entities overlap with ophthalmoparesis and ophthalmoplegia.

Signs and symptoms

Symptoms of conjugate gaze palsies include the impairment of gaze in various directions and different types of movement, depending on the type of gaze palsy. Signs of a person with a gaze palsy may be frequent movement of the head instead of the eyes.[2] For example, a person with a horizontal saccadic (saccade) palsy may jerk their head around while watching a movie or high action event instead of keeping their head steady and moving their eyes, which usually goes unnoticed. Someone with a nonselective horizontal gaze palsy may slowly rotate their head back and forth while reading a book instead of slowly scanning their eyes across the page.[citation needed]

Cause

A lesion, which is an abnormality in tissue due to injury or disease, can disrupt the transmission of signals from the brain to the eye. Almost all conjugate gaze palsies originate from a lesion somewhere in the brain stem, usually the midbrain, or pons. These lesions can be caused by stroke, or conditions such as Koerber-Salus-Elschnig syndrome, Progressive supranuclear palsy, Olivopontocerebellar syndrome, Niemann-Pick Disease, Type C, or envenomation such as from a scorpion sting.[3]

Mechanism

The location of the lesion determines the type of palsy. Nonselective horizontal gaze palsies are caused by lesions in the Abducens nucleus. This is where the cranial nerve VI leaves on its way to the Lateral rectus muscle, which controls eye movement horizontally away from the midline of the body. The cranial nerve VI also has interneurons connecting to the medial rectus, which controls horizontal eye movement towards from the midline of the body.[4] Since the lateral rectus controls movement away from the center of the body, a lesion in the abducens nucleus disrupts the pathways controlling outward movements, not allowing the right eye to move right and the left eye to move left. Nerve VI has the longest subarachnoid distance to its target tissue, making it susceptible to lesions.[5] Lesions anywhere in the abducens nucleus, cranial nerve VI neurons, or interneurons can affect eye movement towards the side of the lesion. Lesions on both sides of the abducens nucleus can cause a total loss of horizontal eye movement.[6]

One other type of gaze palsy is a horizontal saccadic palsy. Saccades are very quick intermittent eye movements.[7] The paramedian pontine reticular formation(PPRF), also in the pons is responsible for saccadic movement, relaying signals to the abducens nucleus.[8] Lesions in the PPRF cause what would be saccadic horizontal eye movements to be much slower or in the case of very severe lesions, nonexistent.[6] Horizontal gaze palsies are known to be linked to Progressive Scoliosis.[9] This occurs because pathways controlling saccadic movements are disrupted by the lesion and only slow movements controlled by a different motor pathway are unaffected.

Lesions in the midbrain can interfere with efferent motor signals before they arrive at the pons. This can also cause slowed horizontal saccadic movements and failure for the eye to reach its target location during saccades. This damage normally happens in the oculomotor nucleus of the midbrain [10] As in horizontal saccadic palsy, the saccades are stopped or slowed from the disrupted pathway, only in this case the signal is disrupted before it reaches the PPRF.

One-and-a-half syndrome is associated with damage to the paramedian pontine reticular formation and the medial longitudinal fasciculus.[11] These combined damages cause both a complete gaze impairment on the ipsilateral side and a "half" gaze impairment on the contralateral side.[6] As seen in horizontal saccadic palsy, the impairment of the contralateral side gaze is caused by the disrupted pathways coming from the PPRF, while the "half" impairment is from the signal passing through the medial longitudinal fascicles not being able to reach its target. One-and-a-Half syndrome is normally associated with horizontal gaze.

Although more rare than horizontal, one-and-a-half syndrome from damage to the paramedian pontine reticular formation and the medial longitudinal fasciculus can be shown to affect vertical gaze. This can cause impairment of vertical gaze, allowing only one eye to move vertically.[6]

Diagnosis

A patient may be diagnosed with a conjugate gaze palsy by a physician performing a number of tests to examine the patient's eye movement abilities. In most cases, the gaze palsy can simply be seen by inability to move both eyes in one direction. However, sometimes a patient exhibits an abduction nystagmus in both eyes, indicating evidence of a conjugate gaze palsy.[12] A nystagmus is a back and forth "jerk" of the eye when attempting to hold a gaze in one direction.[13]

Classification

Conjugate gaze palsies can be classified into palsies affecting horizontal gaze and vertical gaze.[citation needed]

Horizontal gaze palsies

Horizontal gaze palsies affect gaze of both eyes either toward or away from the midline of the body. Horizontal gaze palsies are generally caused by a lesion in the brain stem and connecting nerves, normally in the pons.[6]

Progressive scoliosis

Horizontal gaze palsy with progressive scoliosis (HGPPS) is a very rare form of conjugate gaze palsy, appearing only in a few dozen families worldwide. HGPPS prevents horizontal movement of both eyes, causing people with this condition to have to move their head to see moving objects. In addition to the eye movement impairment, HGPPS is coupled with progressive scoliosis, although eye symptoms usually appear before scoliosis. HGPPS is caused by a mutation in the ROBO3 gene, which is important in cross-over of motor and sensory signals, preventing horizontal eye movement. In addition to the mutation, lesions in the midbrain and pons are common. This can also include a complete absence of a formation in the pons, the facial colliculus, which is responsible for some facial movements.[14] The cause of progressive scoliosis in HGPPS and why HGPPS does not affect vertical gaze is unclear. Progressive scoliosis is normally treated with surgery.[2]

Vertical gaze palsies

Vertical gaze palsies affect movement of one or both eyes either in upward direction, up and down direction, or more rarely only downward direction. Very rarely only movement of one eye in one direction is affected. Vertical gaze palsies are often caused by lesions to the midbrain due to a stroke or a tumor. In the case that only downward gaze is affected, the cause is normally progressive supranuclear palsy.[15]

Treatment

There is no treatment of conjugate gaze palsy itself, so the disease or condition causing the gaze palsy must be treated, likely by surgery.[1] As stated in the causes section, the gaze palsy may be due to a lesion caused by stroke or a condition. Some of the conditions such as Progressive supra nuclear palsy are not curable,[16] and treatment only includes therapy to regain some tasks, not including gaze control. Other conditions such as Niemann-Pick disease type C have limited drug therapeutic options.[17] Stroke victims with conjugate gaze palsies may be treated with intravenous therapy if the patent presents early enough, or with a surgical procedure for other cases.[18]

Prognosis

The prognosis of a lesion in the visual neural pathways that causes a conjugate gaze palsy varies greatly. Depending on the nature of the lesion, recovery may happen rapidly or recovery may never progress. For example, optic neuritis, which is caused by inflammation, may heal in just weeks, while patients with an ischemic optic neuropathy may never recover.[19][20]

References

  1. ^ a b "Conjugate Gaze Palsies: Neuro-ophthalmologic and Cranial Nerve Disorders: Merck Manual Professional". Merckmanuals.com. Retrieved 2013-07-07.
  2. ^ a b "Horizontal Gaze Palsy with Progressive Scoliosis. (2012).Gentics Home Reference". Ghr.nlm.nih.gov. 2013-07-01. Retrieved 2013-07-07.
  3. ^ "Conjugate gaze palsy". RightDiagnosis.com. 2013-05-07. Retrieved 2013-07-07.
  4. ^ "Eye Theory". Cim.ucdavis.edu. Archived from the original on 2011-07-26. Retrieved 2013-07-07.
  5. ^ Abducens Nerve Palsy at eMedicine
  6. ^ a b c d e "Barton, J., & Goodwin, J. (2001). Horizontal Gaze Palsy". Medlink.com. Archived from the original on 2008-03-24. Retrieved 2013-07-07.
  7. ^ "Saccades - definition of Saccades in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia". Medical-dictionary.thefreedictionary.com. Retrieved 2013-07-07.
  8. ^ "University of Western Ontario Department of Physiology. (1996). Basic Principles of Generating Horizontal Saccades". Schorlab.berkeley.edu. 1996-10-04. Retrieved 2013-07-07.
  9. ^ Jain, Nitin R; Jethani, Jitendra; Narendran, Kalpana; Kanth, L (2011). "Synergistic convergence and split pons in horizontal gaze palsy and progressive scoliosis in two sisters". Indian Journal of Ophthalmology. 59 (2): 162–5. doi:10.4103/0301-4738.77012. PMC 3116551. PMID 21350292.
  10. ^ "The Canadian eTextbook of eye movements". Neuroophthalmology.ca. Archived from the original on 2014-03-08. Retrieved 2013-07-07.
  11. ^ Terao, S (2000). "Coexisting vertical and horizontal one and a half syndromes". Journal of Neurology, Neurosurgery & Psychiatry. 69 (3): 401–2. doi:10.1136/jnnp.69.3.401. PMC 1737104. PMID 10991648.
  12. ^ Zee, DS (August 1992). "Internuclear ophthalmoplegia: pathophysiology and diagnosis". Baillière's Clinical Neurology. 1 (2): 455–70. PMID 1344079. NAID 10016339375.
  13. ^ Hertle, Richard W. (September 2008). "Nystagmus in Infancy and Childhood". Seminars in Ophthalmology. 23 (5–6): 307–317. doi:10.1080/08820530802505955. PMID 19085433. S2CID 27757018.
  14. ^ Bomfim, Rodrigo C.; Távora, Daniel G. F.; Nakayama, Mauro; Gama, Rômulo L. (February 2009). "Horizontal gaze palsy with progressive scoliosis: CT and MR findings". Pediatric Radiology. 39 (2): 184–187. doi:10.1007/s00247-008-1058-8. PMID 19020872. S2CID 2344092.
  15. ^ "Conjugate Gaze Palsies: Cranial Nerve Disorders: Merck Manual Home Edition". Merckmanuals.com. Retrieved 2013-07-07.
  16. ^ MedlinePlus Encyclopedia: Progressive supranuclear palsy
  17. ^ Davidson, Cristin D.; Ali, Nafeeza F.; Micsenyi, Matthew C.; Stephney, Gloria; Renault, Sophie; Dobrenis, Kostantin; Ory, Daniel S.; Vanier, Marie T.; Walkley, Steven U. (11 September 2009). "Chronic Cyclodextrin Treatment of Murine Niemann-Pick C Disease Ameliorates Neuronal Cholesterol and Glycosphingolipid Storage and Disease Progression". PLOS ONE. 4 (9): e6951. Bibcode:2009PLoSO...4.6951D. doi:10.1371/journal.pone.0006951. PMC 2736622. PMID 19750228.
  18. ^ Goldstein, Larry B.; Simel, DL (18 May 2005). "Is This Patient Having a Stroke?". JAMA. 293 (19): 2391–2702. doi:10.1001/jama.293.19.2391. PMID 15900010.
  19. ^ Jacobs, D. A.; Galetta, S. L. (1 January 2007). "Neuro-Ophthalmology for Neuroradiologists". American Journal of Neuroradiology. 28 (1): 3–8. PMC 8134093. PMID 17213413.
  20. ^ National Stroke Association. Stroke Treatment.[full citation needed]

Read other articles:

Edinburgh International Conference Centre

Edinburgh International Conference CentreMain building of the EICCGeneral informationStatusCompletedAddressThe Exchange150 Morrison StreetEdinburghEH3 8EETown or cityEdinburghCountryScotland, United KingdomCoordinates55°56′45.99″N 3°12′34.73″W / 55.9461083°N 3.2096472°W / 55.9461083; -3.2096472Construction started1993Completed1995Design and constructionArchitect(s)FarrellsEngineerArupWebsitewww.eicc.co.uk The Edinburgh International Conference Centre (EICC)...

 

Tories (British political party)

Major political faction and then party in the United Kingdom from 1678 to 1834 Tory Party redirects here. For the modern British party popularly known as the Tories, see Conservative Party (UK). For other uses, see Tory Party (disambiguation). Tories Leader(s) Viscount Bolingbroke William Pitt the Younger 2nd Earl of Liverpool Arthur Wellesley Robert Peel Founded1678; 345 years ago (1678)Dissolved1834; 189 years ago (1834)Preceded byCavaliersSucceeded&...

 

Evangelos Zappas

Greek philanthropist and businessman (1800–1865) Evangelos ZappasA portrait of Zappas (Zappeion)Native nameΕυάγγελος ΖάππαςNickname(s)Evangelis (Ευαγγέλης)Born(1800-08-23)23 August 1800Labovo, Pashalik of Yanina, Ottoman Empire[1] (now Albania)Died19 June 1865(1865-06-19) (aged 64)Broșteni, United Principalities of Moldavia and Wallachia (now Romania)BuriedRomania (initially)Labovo (body)Zappeion (skull)AllegianceFirst Hellenic RepublicService/bran...

2022 Canada Cricket World Cup Challenge League A

Cricket tournament 2022 Canada Cricket World Cup Challenge League ADates27 July – 6 August 2022Administrator(s)International Cricket CouncilCricket formatList ATournament format(s)Round-robinHost(s)Cricket CanadaParticipants6Matches15Most runs Hamid Shah (379)Most wickets Nicolaj Laegsgaard (15)← 20192022 → The 2022 Canada Cricket World Cup Challenge League A was played in Canada in July and August 2022.[1] It was the second round of matches in Group A of the 2019–2022...

 

جامعة رايت للولاية مدرسة طب بونشوفت

جامعة رايت للولاية مدرسة طب بونشوفت معلومات التأسيس 1973  الموقع الجغرافي إحداثيات 39°46′40″N 84°03′42″W / 39.7779°N 84.0618°W / 39.7779; -84.0618  البلد الولايات المتحدة  إحصاءات الموقع الموقع الرسمي  تعديل مصدري - تعديل   جامعة رايت للولاية مدرسة طب بونشوفت (بالإنجليز�...

 

Woodley, Berkshire

Town and civil parish in Berkshire, England Human settlement in EnglandWoodleyWoodley Shopping Centre (Precinct)WoodleyLocation within BerkshirePopulation35,470 (2011 Census[citation needed])OS grid referenceSU7673• London35 mi (56 km) ECivil parishWoodleyUnitary authorityWokinghamCeremonial countyBerkshireRegionSouth EastCountryEnglandSovereign stateUnited KingdomPost townReadingPostcode districtRG5Dialling code0118PoliceT...

Ginger dressing

Cuisine This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed.Find sources: Ginger dressing – news · newspapers · books · scholar · JSTOR (June 2018) (Learn how and when to remove this template message) Ginger dressingSalad with ginger dressingAlternative namesSesame ginger dressing, sesame dressingTypeSalad dressing or dipMain...

 

A New Empire

This article is about Ailee EP. For the mobile game, see Final Fantasy XV: A New Empire. For other uses, see New Empire (disambiguation). 2016 EP by AileeA New EmpireEP by AileeReleasedOctober 5, 2016Recorded2016Genre K-pop dance-pop R&B Language Korean English Label YMC Entertainment LOEN Entertainment Ailee chronology Vivid(2015) A New Empire(2016) Butterfly(2019) Singles from A New Empire If YouReleased: August 23, 2016 HomeReleased: October 05, 2016 A New Empire is the fourth ...

 

福建师范大学

坐标：26°1′50″N 119°12′25″E / 26.03056°N 119.20694°E / 26.03056; 119.20694 福建师范大学Fujian Normal University校训知明行笃，立诚致广创办时间1907年9月学校标识码4135010394学校类型公立党委书记潘玉腾校长王长平职工人數2500学生人數本科生3万多名校址 中国福建省福州市仓山校区：仓山区上三路8号旗山校区：大学城科技路1号总面积213.39万平方米網站福建师范大学

Eddie Cantor

American comedian and actor (1892–1964) Eddie CantorCantor in 1945BornIsidore Itzkowitz(1892-01-31)January 31, 1892New York City, U.S.DiedOctober 10, 1964(1964-10-10) (aged 72)Beverly Hills, California, U.S.Resting placeHillside Memorial Park Cemetery in Culver City, CaliforniaOccupationsActorcomediandancersingersongwriterfilm producerscreenwriterauthorYears active1907–1962Spouse Ida Tobias ​ ​(m. 1914; died 1962)​Children52nd Pres...

 

Facultad de Economía, Gobierno y Comunicaciones de la Universidad Central de Chile

Facultad de Economía, Gobierno y Comunicaciones de la Universidad Central de Chile Archivo:Campus Vicente Kovacevic II.jpgForma parte de Universidad Central de ChileFundación 1988 (Escuela de Ciencias Políticas y Administrativas)2000 (Facultad de Ciencias Políticas y Administración Pública) 2017 (Facultad de Gobierno) 2019 (Facultad de Economía, Gobierno y Comunicaciones)LocalizaciónDirección Santa Isabel 1278 Santiago, ChileCampus Vicente Kovacevic IICoordenadas 33°27′10″S 70°39

 

ارتفاق عاني

ارتفاق عاني الاسم العلميsymphysis pubica, symphysis pubis مستوى إكليلي للارتفاق العاني. (يظهر الارتفاق العاني في وسط اليسار.) الحوض 1-عظم العجز2-الحرقفة3-عظم الإسك4-عظم العانة5-الارتفاق العاني6-الحُق7-الثقبة السدادية8-العصعصالحوض 1-عظم العجز2-الحرقفة3-عظم الإسك4-عظم العانة5-الارتفاق العاني6-ا�...

Перелік начальників Генерального штабу України

Ця стаття перелічує начальників генерального штабу українських державних утворень від початку XX століття. Зміст 1 Українська Народна Республіка 1.1 Український генеральний військовий штаб 1.2 Головний штаб УНР 1.3 Генеральний штаб військ Директорії 1.4 Генеральний штаб УНР...

 

First World

Geopolitical grouping of the world's most politically and economically stable nations This article is about the Western political concept. For the Maoist political concept, see Three Worlds Theory. The Three Worlds of the Cold War (between 30 April and 24 June 1975)   First World: Countries aligned with the Western Bloc (i.e., NATO and allies), led by the United States   Second World: Countries aligned with the Eastern Bloc (i.e., Warsaw Pact, China, and allies), led by th...

 

SS Hsin Wah

SS Hsin Wah History Hong Kong NameHsin Wah OwnerChina Merchants Steam Navigation Company BuilderNapier & Miller Yard number235[1] Launched8 June 1921[1] Completed1921[1] FateSank 1929 Notes401 fatalities, 20 rescued[1] General characteristics TypeSteamship Tonnage1940 grt[1] Length82.3 meters[2] Height6.4 meters[2] Depth12.2 meters[2] Installed power162 nhp[1] Propulsiontriple expansion engine[1] Speed10 knots...

Roadside Attractions

Film production company Not to be confused with Roadside attraction. Roadside Attractions, LLCTypePrivateIndustryFilm productionFoundedJuly 27, 2000; 23 years ago (2000-07-27)FoundersHoward CohenEric d’ArbeloffHeadquartersLos Angeles, California, United StatesProductsMotion picturesOwnerLionsgate (43%)Number of employees25Websitewww.roadsideattractions.com Roadside Attractions is an American production company and film distributor based in Los Angeles, California, founded ...

 

Caudron R.4

French WW1 reconnaissance aircraft R.4 and R.5 Role ReconnaissanceType of aircraft Manufacturer Caudron Designer René Caudron First flight June 1915[1] Introduction October 1916 Retired 1918 Primary user Aéronautique Militaire Produced 1916-1917 Number built 249 Caudron R.4[2] + 1 Caudron R.5[3] Variants Caudron R.11 The Caudron R.4 (officially Caudron 40 A.3) was a French World War I twin-engine biplane reconnaissance/artillery cooperation aircraft and the prog...

 

Port Bolivar, Texas

Unincorporated community in Texas, US Aerial view of Port Bolivar at the end of the Bolivar Peninsula in 1999. The Gulf Intracoastal Waterway enters Galveston Bay here. Galveston Bay is at left in this photograph. View is to the northeast. Bolivar Lighthouse -- Point Bolivar Port Bolivar (/ˈbɒlɪvər/ BOL-i-vər) is an unincorporated community located on the northern shore of the western tip of the Bolivar Peninsula, separated from Galveston Island by the entrance to Galveston Bay. The Boli...

Monoamine oxidase A

Endogenous enzyme MAOAAvailable structuresPDBOrtholog search: PDBe RCSB List of PDB id codes2Z5Y, 2BXR, 2BXS, 2Z5XIdentifiersAliasesMAOA, MAO-A, monoamine oxidase A, BRNRSExternal IDsOMIM: 309850 MGI: 96915 HomoloGene: 203 GeneCards: MAOA Gene location (Human)Chr.X chromosome (human)[1]BandXp11.3Start43,654,907 bp[1]End43,746,817 bp[1]Gene location (Mouse)Chr.X chromosome (mouse)[2]BandX A1.2|X 11.78 cMStart16,485,937 bp[2]End16,554,057 bp[2 ...

 

Bethlehem of Galilee

This article is about a town in Galilee. For the city near Jerusalem, see Bethlehem. Place in Northern, IsraelBethlehem of Galilee בֵּית לֶחֶם הַגְּלִילִית‎Bethlehem of GalileeShow map of Jezreel Valley region of IsraelBethlehem of GalileeShow map of IsraelCoordinates: 32°44′12″N 35°11′29″E / 32.73667°N 35.19139°E / 32.73667; 35.19139Grid position167/237 PALCountryIsraelDistrictNorthernCouncilJezreel ValleyAffiliationMoshavi...

 
Kembali kehalaman sebelumnya