Patterns and causes of supranuclear vertical gaze palsy: A retrospective, single-institutional study in 113 patients

Supranuclear vertical gaze palsy (SVGP) is a hallmark feature of progressive supranuclear gaze palsy (PSP). However, it can also occur in a variety of other disorders affecting the upper brainstem. The aim of this study was to provide an overview of potential etiologies of SVGP, and to characterize the associated clinical features.

We retrospectively analyzed data of all patients presenting with SVGP in inpatient and outpatient care in the University Hospital for Neurology Graz between January 2012 and June 2022. SVGP was diagnosed clinically by neurologists and all diagnoses were established based on clinical evaluation.

Of the included 113 patients (66 males, 47 females; mean age: 67.5 years) the most common etiologies were Parkinsonian (n = 50) and vascular disorders (n = 43). Other underlying diagnoses were ataxia syndromes (n = 2), other neurodegenerative disorders (n = 8), autoimmune and inflammatory disorders (n = 3), lysosomal storage diseases (n = 2), neoplastic lesions (n = 2), and others (n = 2). Among Parkinsonian disorders, PSP represented the most frequent diagnosis (n = 37). All patients with downward SVGP were diagnosed with PSP and frequently exhibited additional oculomotor symptoms. In contrast, upward SVGP was more common in Parkinson's disease (PD) (p = 0.004). Vascular lesions were located in the mesencephalon (n = 20), thalamus (n = 10), cerebellum (n = 3), and pons (n = 2) and were more commonly associated with upward SVGP (n = 35) than downward SVGP (n = 3). Similarly, other etiologies were more often linked to upward SVGP (n = 14) than downward SVGP (N = 5).

Parkinsonian and vascular disorders are the most common etiologies of SVGP, but a wide range of disorders must be considered. While upward SVGP has a broad differential diagnosis, downward SVGP is predominantly seen in patients with PSP.