Chapter 9 Abnormalities of vision or eye movement

Video 40 Early progressive supranuclear gaze palsy (Steele Richardson syndrome)

The patient’s range of voluntary eye movements is good, but his vertical saccades, particularly when looking down, are slow.

Video 41 Left abducens (VI) nerve palsy

The left eye fails to abduct on left lateral gaze.

Video 42 Right trochlear (IV) nerve palsy

The head is tilted to the left; on left lateral gaze, the right eye rides up – this is more marked when the head is tilted to the right and corrected by tilting the head to the left.

Video 43 Left internuclear ophthalmoplegia

On right lateral gaze, the left eye fails to fully adduct and the right eye overshoots and then makes correcting nystagmoid movements.

Video 44 Facial and gaze palsy due to pontine metastasis

Widened left palpebral fissure; not blinking on left; loss of left naso-labial fold; unable to raise left eyebrow (frontalis); unable to screw up left eye (orbicularis oculi); left cheek blows out (buccinator weakness); able to look to the right but not the left (left gaze palsy). CT: multiple lesions including one in the left pons.

Video 45 Parinaud’s syndrome

On attempted upward gaze, the eyes jerk rhythmically towards each other.

Video 46 Parinaud’s syndrome

On attempted upward gaze, the eyes retract rhythmically into the orbits.

Video 47 Horizontal nystagmus

On left lateral gaze, there is horizontal nystagmus with the fast phase to the left; on right lateral gaze, there is horizontal nystagmus with the fast phase to the right.

Video 48 Vertical nystagmus on downward gaze, fast phase down

Video 49 Horizontal pendular nystagmus

This is present continuously in the primary position and increases in amplitude on lateral gaze. No fast and slow phase.