Clinical Correlation Between Vertical Gaze Palsy and Midbrain Volume in Progressive Supranuclear Palsy

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Title Clinical Correlation Between Vertical Gaze Palsy and Midbrain Volume in Progressive Supranuclear Palsy
Creator Karen A. Buch; Marc A. Bouffard; Randy H. Kardon; Anne-Marie A. Wills; Claudio M. Privitera; Mansi Sharma; Shirley H. Wray
Affiliation Department of Radiology (KB), Massachusetts General Hospital, Boston, Massachusetts; Department of Neuro-Ophthalmology (MB), Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Ophthalmology and Visual Sciences (RHK), University of Iowa Hospital and Clinics, Iowa City, Iowa; Iowa City VA Center for the Prevention and Treatment of Visual Loss (RHK), Iowa City VA Health Care System, Iowa City, Iowa; Department of Neurology (A-MW, MS, SHW), Massachusetts General Hospital, Boston, Massachusetts; and School of Optometry (CP), University of California, Berkeley, California
Abstract Background: Supranuclear vertical gaze palsies and slowed vertical saccades are characteristic clinic features of progressive supranuclear palsy (PSP). The 'hummingbird sign,' reflective of midbrain atrophy, is a classic radiographic sign of PSP. Correlation between eye movement abnormalities and radiographic findings in PSP has been reported previously. However, due to the use of clinical criteria not commonly employed in neuro-ophthalmic practice and neuroimaging techniques that are not widely available, it remains unclear whether correlation between midbrain structure and characteristic ocular-motor disturbances can be helpful to neuro-ophthalmologists seeking to adjudicate difficult or unusual diagnostic cases. Methods: Patients with a diagnosis of probable PSP according to Movement Disorders Society criteria were studied retrospectively. A neuroradiologist calculated brainstem volumes in enrolled participants and normal controls. Spearman correlations were used to correlate the extent of eye movement limitation as assessed by 2 neuro-ophthalmologists with brainstem volumes. Results: Fourteen participants with PSP and 15 healthy controls with similar age and gender distribution were enrolled and evaluated retrospectively. All 14 participants with PSP had undergone MRIs. Midbrain atrophy significantly correlated with the PSP rating scale (P < 0.001). PSP patients had significantly reduced volumes in the midbrain (P -0.0026), tegmentum (0.0001), tectum (0.0001), and medulla (P = 0.0024) compared with normal controls. Notes documenting quantified ocular motor function were available in 7 of 14 participants with PSP. Midbrain atrophy significantly correlated with in the extent of upward gaze limitation (P = 0.03). Conclusions: The severity of upward gaze limitation correlates with the severity of midbrain atrophy in patients with PSP. Recognition of this correlation may help to adjudicate diagnostic dilemmas and guide further evaluation.
Subject Atrophy; Magnetic Resonance Imaging; Mesencephalon; Retrospective Studies; Strabismus; Progressive Supranuclear Palsy; Tegmentum Mesencephali
OCR Text Show
Date 2022-06
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, June 2023, Volume 43, Issue 2
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s64s4a63
Setname ehsl_novel_jno
ID 2307871
Reference URL https://collections.lib.utah.edu/ark:/87278/s64s4a63
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