Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, The Johns Hopkins School of Medicine
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.
1, ocular motor signs in PSP
Daniel R. Gold, D.O.
Spencer S. Eccles Health Sciences Library, University of Utah