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Case Report: Bilateral Horizontal Gaze Palsy (1 + 1 Syndrome): A Supranuclear Gaze Palsy
Summary
This case report details a rare instance of bilateral horizontal gaze palsy in a multiple sclerosis patient. The condition stemmed from demyelinating lesions affecting crucial eye movement pathways in the brainstem.
Area of Science:
- Neuroscience
- Ophthalmology
- Neurology
Background:
- Multiple sclerosis (MS) can manifest with diverse neurological symptoms, including those affecting ocular motility.
- Understanding the complex horizontal gaze pathway is crucial for diagnosing palsies.
Observation:
- A 43-year-old woman with recent MS diagnosis presented with complete horizontal gaze palsy but intact vertical eye movements.
- Neuroimaging revealed demyelinating lesions in the bilateral paramedian pontine reticular formations (PPRF) and left abducens nerve.
Findings:
- The patient exhibited a supranuclear horizontal gaze palsy due to bilateral PPRF lesions.
- A mild left infranuclear abducens nerve palsy was also identified, evidenced by largely intact vestibulo-ocular reflex (VOR).
Implications:
- This case highlights the importance of detailed clinical examination of extraocular movements in diagnosing complex gaze palsies.
- Accurate localization of lesions through clinical findings guides targeted neuroimaging in MS patients.
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