A conjugate gaze palsy is inability to move both eyes together in a single horizontal (most commonly) or vertical direction. A supranuclear gaze palsy is an inability to look in a vertical direction as a result of cerebral impairment. Vertical gaze palsy (VGP) is a conjugate gaze palsy that results in the inability to move both eyes in a single vertical direction (upgaze or downgaze or both). [1] PSP is recognized as a tauopathy, with a middle age … Downward gaze palsy is usually pathologic and may be seen in brainstem lesions and certain neurodegenerative disorders such as progressive supranuclear palsy or adult Niemanns-Pick disease. Parinaud syndrome, also known as the dorsal midbrain syndrome, is a supranuclear vertical gaze disturbance caused by compression of the superior tectal plate. Vertical gaze palsy for either upward or downward gaze is rarely present at symptom onset (8%), usually takes 3–4 years to develop, and precedes the development of horizontal gaze palsy. Usually, upward gaze is affected. 2016 2017 2018 2019 2020 2021 Billable/Specific Code. Vertical gaze palsy Vertical gaze decreases gradually with age, but vertical gaze palsy is more severe than age-related changes. To our knowledge, only one previous case has been reported of a patient with an acute vertical gaze palsy and an isolated thalamic infarction on MRI. 6 In this case, however, the rostral midbrain (the level of … (See also Overview of Neuro-ophthalmologic and Cranial Nerve Disorders .) Progressive supranuclear palsy (PSP) or Steele-Richardson-Olszewski syndrome is characterized by a progressive supranuclear ophthalmoplegia typically vertical but in particular downward limitation of eye movement. Gaze palsies most commonly affect horizontal gaze; some affect upward gaze, and fewer affect downward gaze. The most common cause of vertical gaze palsy is damage to the top part of the brain stem (midbrain), usually by a stroke or tumor. Interpretation of limited vertical gaze should be undertaken with care because restricted upward gaze is seen in the normal elderly. This vertical palsy is supranuclear, so doll's head maneuver should elevate the eyes, but eventually all upward gaze mechanisms fail. The authors attributed the vertical gaze palsy to the mesencephalic lesions. PSP Richardson’s syndrome, the most frequent form of the disease, is characterized by vertical supranuclear gaze palsy and postural instability … VSGP is present in approximately 65 % of the cases and is, with gelastic ca … Palsy (spasm) of conjugate gaze. It usually occurs bilaterally; however, it is occasionally seen unilaterally (Rubin 2014). There is a loss of the voluntary aspect of eye movements, but, as the brainstem is still intact, all the reflex conjugate eye movements are normal. 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