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