Ocular Motor Signs in Progressive Supranuclear Palsy (PSP)

𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 65-yo-woman complaining of imbalance and double vision. She had significant convergence insufficiency (and would close her right eye with near viewing), providing an explanation for her diplopia. Convergence insufficiency is very common with parkinsonism. She had bradykinesia and rigidity, and given a supranuclear vertical gaze disorder, she was subsequently diagnosed with progressive supranuclear palsy (PSP). She had a variety of commonly-seen ocular motor findings on her exam including improved vertical gaze with the vestibulo-ocular reflex, saccadic (choppy) smooth pursuit and VOR suppression, hypometric horizontal saccades, square wave jerks, and she demonstrated other typical signs of PSP including astonished facies with eyelid retraction, procerus sign, and the applause sign. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: Seen in this video are convergence insufficiency (frequent closure of the right eye to minimize diplopia), supranuclear gaze palsy (with sparing of the vertical vestibulo-ocular reflex), saccadic smooth pursuit and VOR suppression, hypometric horizontal saccades, square wave jerks, astonished facies with eyelid retraction, procerus sign, and the applause sign. https://collections.lib.utah.edu/ark:/87278/s60p4nv0