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Supranuclear Paralysis of Downgaze 907-3
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Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Dec 16, 2015

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Page 1: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Supranuclear Paralysis of Downgaze

907-3

Page 2: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Eye Movements

Global paralysis of downgaze

Absent convergence

Slow saccades on upgaze

Deviation of the eyes up under forced eye closure (Bell phenomenon)

Horizontal gaze nystagmus to the right

Page 3: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Eye Movements

Optokinetic nystagmus absent with vertical rotation of the drum

Normal vertical oculocephalic reflex

Skew deviation, right hypertropia

Left head tilt – left ocular tilt reaction

Page 4: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 1. Anatomical variants of the origin of the paramedian thalamic arteries form the basilar communicating arteries. Types IIa and IIb are those associated with bilateral paramedian thalamic infarction (adapted from Percheron [3]).

Page 5: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Post-Stroke

Page 6: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Post-Stroke

Page 7: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Post-Stroke

Page 8: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 2. Cut surface of bilateral rostral midbrain infarcts, x2.5.

Page 9: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 5. Transverse section through caudal to infarcts demonstrating the sparing of 3rd nerve nucleus and the interstitial nucleus of Cajal.

Page 10: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 6. Transverse sections through mesodiencephalic junction demonstrating bilateral infarcts outlined with stippling as described in the text. This section demonstrates the largest extent of the lesions. Hematoxylin and eosin plus luxol fast blue, x 4.5.

Page 11: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

List of abbreviations for figures

A = Cerebral aqueductBIS = Brachium of the inferior

colliculusCM = CentromedianumCP = Cerebral peduncleEW = Edinger Westphal nucleusFR = Fasciculus retroflexusH = HabenulaIS = Interstitial nucleus of CajalMB = Mammillary bodyMD = Medial dorsal nucleusMG = Medial geniculate nucleusML = Medial lemniscus

MT = Mammilothalamic tractP = PretectumPC = Posterior commissure and its

nucleiPIC = Posterior limb of internal

capsulePN = Pulvinar nucleiRN = Red nucleusSC = Superior colliculusSNi = Substantia nigraSNu = Substantia nucleusZI = Zona incertaIII = Third nerve nucleusIII V = Third ventricle

Page 12: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 7. Transverse section through ventral diencephalon. The bilateral infarcts have nearly disappeared. Hemtoxylin and eosin plus luxol fast blue, x 4.5

Page 13: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 8.

Page 14: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 9. Four lesions giving rise to upward gaze paralysis superimposed on a sagittal section of the human brain. The enlargement of the lesions on the right shows that the commons areas involved (stippled) include iC, nD and fibres of the posterior commissure. All lesions shown here are unilateral (see text).

Page 15: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 10. Case Hu. A sagittal view of the brain. Cross-hatched area denotes the total lesion which gave rise to paralysis of smooth pursuit and fast upward and downward eye movements. Lesion on the right is indicated by horizontal lines, the left by vertical lines. The overlapping area represents the region bilaterally destroyed. iC and nD were almost completely spared by this lesion.

Page 16: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 11.

Page 17: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 12.

Page 18: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 13.

Page 19: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 14.

Page 20: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 15.

Page 21: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 16. Five unilateral or bilateral lesions giving rise to upward and downward gaze paralysis superimposed on a sagittal section of the human brain. The enlargement on the right shows that the common areas involved (strippled) include rostral iMLF (nMLF), iC, and nD.

Page 22: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

Figure 17. Sagittal section through the human brain on which the bilaterally destroyed areas in the six cases of downward gaze paralysis are superimposed. The enlargement of the lesions on the right shows that the common areas destroyed in these cases (stippled) ties above the red nucleus at the level of tractus retroflexus (TR), that is around aD and rostral iMLF (nMLF).

Page 23: Supranuclear Paralysis of Downgaze 907-3. Eye Movements Global paralysis of downgaze Absent convergence Slow saccades on upgaze Deviation of the eyes.

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