Identifier |
PSP_with_complete_ophthalmoplegia_and_inability_to_suppress_the_VOR |
Title |
PSP with Complete Ophthalmoplegia and Inability to Suppress the VOR |
Alternative Title |
Video 4.39 Advanced progressive supranuclear palsy (PSP) with complete ophthalmoplegia but preservation of the horizontal vestibulo-ocular reflex (VOR) from Neuro-Ophthalmology and Neuro-Otology Textbook |
Creator |
Daniel R. Gold, DO |
Affiliation |
(DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland |
Subject |
Progressive Supranuclear Palsy (PSP); VOR Supression; Mesencephalon; Horizontal Gaze Palsy; Vertical Gaze Palsy |
Description |
๐ข๐ฟ๐ถ๐ด๐ถ๐ป๐ฎ๐น ๐๐ฒ๐๐ฐ๐ฟ๐ถ๐ฝ๐๐ถ๐ผ๐ป: This is a 65-year-old woman presenting with visual complaints in the setting of advanced progressive supranuclear palsy (PSP). She had complete vertical and horizontal ophthalmoplegia, although the vestibulo-ocular reflex (VOR) could overcome the horizontal gaze palsy (but not the vertical gaze palsy). When VOR suppression was tested by having the patient look at the light of the camera while rotating (combined eye-head movement) in a chair, the intact VOR drove the eyes to the right when the chair was turned to the left and to the left when the chair was turned to the right. In this case, she was completely unable to suppress her VOR. Normally, when VOR suppression (VORS) is impaired, the appearance is choppy or saccadic - this is explained by saccades supplementing the impaired pursuit/VORS response. In her case, she was unable to generate saccades, so the eyes drifted laterally (due to an intact VOR) without a mechanism (i.e., saccades) to get them back to the fixation target. MRI demonstrated โMickey mouse sign', an appearance created by midbrain tegmentum atrophy on axial images. ๐ก๐ฒ๐๐ฟ๐ผ-๐ผ๐ฝ๐ต๐๐ต๐ฎ๐น๐บ๐ผ๐น๐ผ๐ด๐ ๐ฎ๐ป๐ฑ ๐ก๐ฒ๐๐ฟ๐ผ-๐ผ๐๐ผ๐น๐ผ๐ด๐ ๐ง๐ฒ๐
๐๐ฏ๐ผ๐ผ๐ธ ๐๐ฒ๐ด๐ฒ๐ป๐ฑ: This patient had complete vertical and horizontal ophthalmoplegia, although the VOR could overcome the horizontal gaze palsy (but not the vertical gaze palsy). When VOR suppression was tested by having the patient look at the light of the camera while rotating (combined eye-head movement) in a chair, the intact VOR drove the eyes to the right when the chair was turned to the left and to the left when the chair was turned to the right. In this case, she was completely unable to suppress her VOR. Normally, when VOR suppression (VORS) is impaired, the appearance is choppy or saccadic - this is explained by saccades supplementing the impaired pursuit/VORS response. In her case, she was unable to generate saccades, so the eyes drifted laterally (due to an intact VOR) without a mechanism (i.e., saccades) to get them back to the fixation target. MRI demonstrated โMickey mouse sign', an appearance created by midbrain tegmentum atrophy on axial images. https://collections.lib.utah.edu/ark:/87278/s6wx2sks |
Date |
2020-04 |
Language |
eng |
Format |
video/mp4 |
Type |
Image/MovingImage |
Collection |
Neuro-Ophthalmology Virtual Education Library: Dan Gold Collection: https://novel.utah.edu/Gold/ |
Publisher |
North American Neuro-Ophthalmology Society |
Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
Rights Management |
Copyright 2016. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
ARK |
ark:/87278/s6wx2sks |
Setname |
ehsl_novel_gold |
ID |
1540451 |
Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6wx2sks |