Complete Saccadic Palsy Due to Pulmonary Thrombectomy

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Identifier Complete_saccadic_palsy_after_pulmonarythrombectomy
Title Complete Saccadic Palsy Due to Pulmonary Thrombectomy
Subject Saccades; Horizontal Gaze Palsy; Vertical Gaze Palsy; Upgaze Palsy; Downgaze Palsy
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine
Description This is a 37-year-old woman who underwent pulmonary thrombectomy for a pulmonary embolus. Immediately following the procedure, she was unable to make normal eye movements. This video exam (she is the passenger in a car during a telemedicine appointment) was performed 4 months after the onset. She was unable to make saccades horizontally or vertically, although horizontal and vertical smooth pursuit and the vestibulo-ocular reflexes (VOR) were intact, as was the range of eye movements. When asked to look out the window at passing scenery (i.e., an optokinetic stimulus), the slow phase was clearly present, but because she could not generate a fast phase (saccades), the eyes were pinned to the right side. This could happen while walking and looking to the sides as well. ; ; This patient had a pure saccadic palsy in both horizontal and vertical planes; therefore, this did not localize to the paramedian pontine reticular formation (PPRF) or rostral interstitial medial longitudinal fasciculus (riMLF), respectively. Because the excitatory burst neurons (EBN, responsible for saccades) and the omnipause cells are both ensheathed by the perineuronal nets, and because a patient with this rare disorder at autopsy was shown to have normal EBN and omnipause cells, the prevailing theory for a post-surgery saccadic palsy is that ischemia of the perineuronal nets may be the culprit. ; ; Case reports of this rare occurrence (typically post-cardiac surgery) have demonstrated that deficits are permanent. Fortunately, she was able to adapt by using head movements (the vestibulo-ocular reflex) to move the eyes in the intended direction.
References Eggers S, Horn A, Roeber S, et al. Saccadic palsy following cardiac surgery: a review and new hypothesis. Ann N Y Acad Sci. 2015 April ; 1343(1): 113-119.
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2020
Type Image/MovingImage
Format video/mp4
Relation is Part of NOVEL: Neuro-ophthalmology Virtual Education Library Examination Collection
Rights Management Copyright 2020. For further information regarding the rights to this collection, please visit:
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
Language eng
ARK ark:/87278/s68h45z9
Setname ehsl_novel_gold
Date Created 2020-07-09
Date Modified 2021-06-28
ID 1580489
Reference URL