Bilateral Horizontal Gaze Palsy and Oculopalatal Tremor Due to Pontine Hemorrhage

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Identifier Bilateral_horizontal_gaze_and_OPT
Title Bilateral Horizontal Gaze Palsy and Oculopalatal Tremor Due to Pontine Hemorrhage
Subject VOR HIT Abnormal, Horizontal Gaze Palsy, OMS PONS, Pendular Nystagmus, Oculopalatal
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 70-yo-woman experienced headache and diplopia and was found to have a hemorrhage centrally within the dorsal pons. Months after the onset, the patient was seen in clinic and had no horizontal eye movements (pursuit, saccades, VOR) in either eye, suggestive of bilateral nuclear 6th nerve palsies. She could overcome her adduction deficits mildly with convergence. Months after the onset, oscillopsia was also experienced and vertical pendular nystagmus was appreciated (seen in the video). Her MRI showed bilateral inferior olive hypertrophy in the medulla (i.e., T2 hyperintensity of the inferior olives), which is seen with oculopalatal tremor. Depending on which inferior olive cell populations are preferentially involved or spared, either palatal tremor or pendular nystagmus may be seen individually or in combination. In this patient's case, there was nystagmus without palatal tremor, due to involvement of the central tegmental tract involvement in the dorsal pons.
Imaging 1, Patient with bilateral horizontal gaze palsies and oculopalatal tremor.
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2016
Type Image/MovingImage
Format video/mp4
Rights Management Copyright 2016. For further information regarding the rights to this collection, please visit:
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
File Name bilateral_horizontal_gaze_and_OPT-Gold.mp4
Language eng
ARK ark:/87278/s6w12vv7
Setname ehsl_novel_gold
Date Created 2017-04-20
Date Modified 2018-01-22
ID 1248075
Reference URL
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