Gaze palsy

Gaze palsy is a symptom where one is unable to voluntarily move both eyes in the same direction across the midline. It can be nuclear or supranuclear in origin.

• Due to lesion of the
  • Cortical gaze centre -> supranuclear
  • The connections between them -> supranuclear
  • Brainstem gaze centre -> nuclear
• Supranuclear gaze palsy -> movement can still be elicited by reflex eye movements (oculocephalic reflex, caloric testing)
  • Because these reflexes don't depend on supranuclear structures
• Nuclear gaze palsy -> movement cannot be elicited by reflexes

• Horizontal gaze palsy = eyes can’t be moved in one or both of the horizontal directions
  • Most common gaze palsy
  • Etiology
    • Stroke in pons
• Vertical gaze palsy = eyes can’t be moved in one or both of the vertical directions
  • Etiology
    • Stroke in midbrain
    • Pinealoma
    • Multiple sclerosis
• Downward gaze palsy = eyes can’t be moved downward, other directions ok
  • Etiology
    • Progressive supranuclear palsy
• Internuclear ophthalmoplegia
  • = lesion of one or both medial longitudinal fasciculi
  • Can be considered as a supranuclear gaze palsy
  • Etiology
    • Multiple sclerosis
    • Stroke
    • Brainstem tumor
  • Clinical features
    • Impaired adduction of the ipsilateral eye
    • Abduction nystagmus of the contralateral eye
    • One or both eyes can be affected