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Movement disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
Pseudobulbar palsy manifests as dysarthria and dysphagia. Speech is slow and quiet. Generalised hyperreflexia, a positive jaw jerk and frontal release signs (see page 112) may be present on examination. Cognitive features are those of subcortical dementia. There may also be palilalia (repetition of words) and emotional lability. There is an increased incidence of hypertension among people with PSP, possibly due to involvement of the brainstem adrenergic nuclei.112 Urinary incontinence commonly develops. The onset of the condition is usually symmetrical in distribution. It is often misdiagnosed before the development of characteristic features such as gaze palsy. A non-specific prodromal illness may precede motor and cognitive impairment.
Disruptions in physical substrates of vision following traumatic brain injury
Published in Mark J. Ashley, David A. Hovda, Traumatic Brain Injury, 2017
The supranuclear portion of the oculomotor system is less commonly involved in TBI and, when present, usually is secondary to a contusion to the general area of the frontal eye fields or its connections. This results in horizontal gaze palsy. Horizontal and vertical gaze palsy can result in brain stem lesions, but in those conditions, there is usually a plethora of other brain stem neurological abnormalities on exam. Disorders of the primary visual system, the retinogeniculocortical tract, results in scotoma or visual field defect. A scotoma is defined as an area of partial attenuation or loss of visual acuity surrounded by an area of normal preserved vision. Lesions in the optic nerve cause monocular scotoma, the shape of which is dependent upon which nerve fibers are involved. Lesions of the optic chiasm usually result in a bitemporal hemianopsia or blindness in the temporal half of both visual fields. Retrochiasmal lesions cause contralateral hemianopsia, which is blindness in one half of the visual field. Lesions in the optic tract produce incongruous visual field defects because the fibers from each eye are still not adjacent to each other. Posterior optic radiation lesions result in homonymous quadranopsias, primary visual cortex lesions sparing the posterior portion result in macular sparing homonymous hemianopsias, and total bilateral primary visual cortex lesions cause bilateral homonymous hemianopsias.
Disorders of Sensation, Motion, and Body Schema
Published in Rolland S. Parker, Concussive Brain Trauma, 2016
A blurry or double image is caused by a lack of ocular fusion since the perceived object is projected to noncorresponding points of the retina. It may be monocular or binocular, and the determination is aided by covering one eye. It is more frequent with lesions on the extraocular muscles or the ocular motor nerves rather than supranuclear brain stem lesions (structures other than the motor neurones), which often result in gaze palsy. Multiple images in grid-like patterns suggest parietooccipital region damage with field and other complex defects.
Training high level balance and stepping responses in atypical progressive supranuclear palsy: a case report
Published in Physiotherapy Theory and Practice, 2023
Earllaine Croarkin, Krystle Robinson, Christopher J. Stanley, Cris Zampieri
This case report describes a patient with balance and gaze palsy concerns which interfered with high-level leisure activities. To understand the impairments and complex effect of the disease on balance function, objective tests such as gait analysis, foot clearance analysis, and computerized posturography are used, along with a few selected clinical tests (Nath et al., 2003). Improved understanding of the disease amongst healthcare workers and the public can enhance recognition and diagnosis of the disease and atypical presentations (Höglinger et al., 2017; Lopez, Bayulkem, and Hallett, 2016). Therefore, therapists may seek published case reports for guidance. This case report provides guidance by offering a detailed description of patient assessment and an exercise intervention for a high functioning patient with atypical PSP.
Apraxia of eyelid opening secondary to possible progressive supranuclear palsy: a case report
Published in International Journal of Neuroscience, 2021
Wei Jiang, Lin Gan, Yang Sun, Ming Dong, Peng Yu
Neurological examination revealed upward gaze palsy with no nystagmus. Bilateral pupillary reflex was normal and symmetrical. Bradykinesia and cogwheeling tone were observed; however, there were no resting tremors. Deep tendon reflexes in the upper limbs were normal, while those in the lower limbs were diminished. Rapid alternating movements were slower than normal. He had a medical history of hepatitis B and indulged in moderate smoking and occasional alcohol intake. Brain magnetic resonance imaging, laboratory tests for anti-muscle-specific tyrosine kinase and anti-acetylcholine receptor antibodies, and single-fiber electromyography were unremarkable. Brain positron emission tomography (PET) revealed a reduction in glucose metabolism in the left part of the medial frontal lobe, basal ganglia, and temporal, occipital, and cingulate cortex. According to the diagnostic criteria of the National Institute of Neurological Disorders and Stroke and the Society for Progressive Supranuclear Palsy (NINDS-SPSP), the patient was diagnosed with possible progressive supranuclear palsy (PSP) [1]. Here, we present a video showing AEO in this patient in order to provide a better understanding of the clinical manifestation of this rare condition (Supplementary Video).
Horizontal Gaze Palsy with Progressive Scoliosis: A Case Report and Literature Review
Published in Neuro-Ophthalmology, 2019
The ROBO3 gene plays a role in the regulation of hindbrain axonal midline crossing and helps cell migration. Mutations of ROBO3 result in abnormal horizontal eye movement, progressive scoliosis, brainstem malformation, and defective crossing of brainstem neuronal pathways.6,9 Horizontal gaze palsy is a major ophthalmologic finding. Nystagmus and ametropia are other important ophthalmologic findings for these patients, which can lead to amblyopia and permanent poor vision.10–13 Horizontal gaze palsy in these patients is probably related to aberrant supranuclear input onto the abducens motoneurons from the pontine reticular formation that cannot cross the midline, and inability of the developing axons in the medial longitudinal fasciculus to cross the midline. The mechanism of the scoliosis aspect is less clear, but it may result from a lack of normal contralateral pathways to spinal muscles.14–16