Walsh & Hoyt: Other Abnormalities of Eye Movement

Patients with increased ICP may appear to have a generalized restriction of eye movements that, when tested carefully, can be found to be supranuclear in origin. In many of these cases, the patient may simply be unable to cooperate fully during the testing. In addition, patients with acute and chronic hydrocephalus from both supratentorial and infratentorial tumors may develop limitation of vertical gaze from pressure on the mesencephalon. In such cases, the limitation of movement may be considered falsely localizing with respect to the location of the tumor. Supratentorial tumors may damage the vestibular pathways, usually via the mechanism of increased ICP, and produce various types of nystagmus, including upbeat, downbeat, torsional, and mixed.