Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine
This is a 75-year-old woman with a diagnosis of progressive supranuclear palsy (PSP). Examination demonstrated vertical supranuclear gaze palsy (i.e., it could be overcome by the vertical vestibulo-ocular reflex [VOR]), saccadic smooth pursuit and VOR suppression (not shown), and hypometric and slow horizontal saccades, and with an optokinetic flag, there were weak fast phases (saccades) horizontally, and absent fast phases vertically. Slowing of downward saccades and loss of the downward fast phase with an optokinetic flag are commonly early signs in PSP, which tend to precede the development of the downgaze/vertical palsy. Additionally, patients with PSP tend to have difficulty suppressing blinks when a bright light is shone into the eyes - a finding akin to the glabellar reflex, which is often present in neurodegenerative conditions such as Parkinson's disease.
Spencer S. Eccles Health Sciences Library, University of Utah