Vertical gaze palsy (VGP) is a conjugate gaze palsy that results in the inability to move both eyes in a single vertical direction (upgaze or downgaze or both). Parinaud syndrome, also known as the dorsal midbrain syndrome, is a supranuclear vertical gaze disturbance caused by compression of the superior tectal plate. (See also Overview of Neuro-ophthalmologic and Cranial Nerve Disorders .) Progressive supranuclear palsy (PSP) or Steele-Richardson-Olszewski syndrome is characterized by a progressive supranuclear ophthalmoplegia typically vertical but in particular downward limitation of eye movement. Pseudo-Argyll Robertson pupils: Accommodative paresis ensues, and pupils become mid-dilated and show light-near dissociation. To our knowledge, only one previous case has been reported of a patient with an acute vertical gaze palsy and an isolated thalamic infarction on MRI. [1] PSP is recognized as a tauopathy, with a middle age … The authors attributed the vertical gaze palsy to the mesencephalic lesions. 6 In this case, however, the rostral midbrain (the level of … There is often associated loss of balance due to degeneration of neurons in the brainstem and basal ganglia. Interpretation of limited vertical gaze should be undertaken with care because restricted upward gaze is seen in the normal elderly. A conjugate gaze palsy is inability to move both eyes together in a single horizontal (most commonly) or vertical direction. Vertical gaze palsy Vertical gaze decreases gradually with age, but vertical gaze palsy is more severe than age-related changes. A supranuclear gaze palsy is an inability to look in a vertical direction as a result of cerebral impairment. Downward gaze palsy is usually pathologic and may be seen in brainstem lesions and certain neurodegenerative disorders such as progressive supranuclear palsy or adult Niemanns-Pick disease. Vertical supranuclear gaze palsy (VSGP) is a key clinical feature in patients with Niemann-Pick type C disease (NP-C), a rare, autosomal recessive, neuro-visceral disorder caused by mutations in either the NPC1 or NPC2 gene. Palsy (spasm) of conjugate gaze. Usually, upward gaze is affected. Vertical gaze palsy for either upward or downward gaze is rarely present at symptom onset (8%), usually takes 3–4 years to develop, and precedes the development of horizontal gaze palsy. PSP Richardson’s syndrome, the most frequent form of the disease, is characterized by vertical supranuclear gaze palsy and postural instability … Gaze palsies most commonly affect horizontal gaze; some affect upward gaze, and fewer affect downward gaze. It usually occurs bilaterally; however, it is occasionally seen unilaterally (Rubin 2014). VSGP is present in approximately 65 % of the cases and is, with gelastic ca … 2016 2017 2018 2019 2020 2021 Billable/Specific Code. 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