The authors attributed the vertical gaze palsy to the mesencephalic lesions. 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. 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. Palsy (spasm) of conjugate gaze. It usually occurs bilaterally; however, it is occasionally seen unilaterally (Rubin 2014). Parinaud syndrome, also known as the dorsal midbrain syndrome, is a supranuclear vertical gaze disturbance caused by compression of the superior tectal plate. PSP Richardson’s syndrome, the most frequent form of the disease, is characterized by vertical supranuclear gaze palsy and postural instability … 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. Gaze palsies most commonly affect horizontal gaze; some affect upward gaze, and fewer affect downward gaze. A supranuclear gaze palsy is an inability to look in a vertical direction as a result of cerebral impairment. Usually, upward gaze is affected. Vertical gaze palsy Vertical gaze decreases gradually with age, but vertical gaze palsy is more severe than age-related changes. VSGP is present in approximately 65 % of the cases and is, with gelastic ca … (See also Overview of Neuro-ophthalmologic and Cranial Nerve Disorders .) Vertical supranuclear gaze palsy (VSGP) is a key clinical feature in patients with Niemann-Pick type C disease (NP-C), a rare, autosomal recessive, neuro-visceral disorder caused by mutations in either the NPC1 or NPC2 gene. [1] PSP is recognized as a tauopathy, with a middle age … 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. Pseudo-Argyll Robertson pupils: Accommodative paresis ensues, and pupils become mid-dilated and show light-near dissociation. Interpretation of limited vertical gaze should be undertaken with care because restricted upward gaze is seen in the normal elderly. 6 In this case, however, the rostral midbrain (the level of … 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. 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). 2016 2017 2018 2019 2020 2021 Billable/Specific Code. 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