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Case Report
 
Vertical gaze palsy in Parkinsonism: An alternative diagnosis to progressive supranuclear palsy
Jonathan Hyer1, Haziq Raees Chowdhury2, Richard Men Ho Lee3, Syed Taseer Hasan4
1MBBS, Ophthalmic Senior House Officer, Ophthalmology Department, Maidstone Hospital, Maidstone, UK.
2MBBS, BSc, Ophthalmic Senior House Officer, Ophthalmology Department, Maidstone Hospital, Maidstone, UK.
3MBBS, BSc, Ophthalmic Registrar, Ophthalmology Department, Maidstone Hospital, Maidstone, UK.
4FRCOphth, Ophthalmic Consultant, Ophthalmology Department, Maidstone Hospital, Maidstone, UK.

doi:10.5348/ijcri-201486-CR-10397

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MD Department of Pediatrics, Lincoln Medical & Mental Health Center
234 East 149th Street
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How to cite this article
Hyer J, Chowdhury HR, Lee RMH, Hasan ST. Vertical gaze palsy in Parkinsonism: An alternative diagnosis to progressive supranuclear palsy. Int J Case Rep Images 2014;5(7):492–495.


Abstract
Introduction: Vertical gaze palsy is a highly relevant clinical sign in Parkinsonian syndromes. As the eponymous sign of progressive supranuclear palsy (PSP), it is a core feature of this disease. However, the differential diagnosis of vertical gaze palsy in patients with Parkinsonism is rarely considered.
Case Report: We present a case of a 65-year-old male with Parkinsonism who presented with diplopia secondary to oculomotor dysfunction and vertical gaze palsy. Computed tomography (CT) sacn demonstrated a thalamic hemorrhage with intraventricular extension. Neurosurgical intervention was not required. The patient's spectacles were fitted with a temporary Fresnel prism over the left lens to relieve diplopia. This progressively improved without the need for strabismus surgery.
Conclusion: Vertical gaze dysfunction occurs in patients with thalamic hemorrhage and is an important differential diagnosis of vertical gaze palsy in Parkinsonism.

Keywords: Parkinson's disease, Vertical gaze palsy, Progressive supranuclear palsy, Thalamic haemorrhage


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Author Contributions
Jonathan Hyer – Conception and design, Drafting the article, Final approval of the version to be published
Haziq Raees Chowdhury – Acquisition of data, Analysis and interpretation of data, Critical revision of the article, Final approval of the version to be published
Richard Men Ho Lee – Acquisition of data, Analysis and interpretation of data, Critical revision of the article, Final approval of the version to be published
Syed Taseer Hasan – Acquisition of data, Analysis and interpretation of data, Critical revision of the article, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2014 Jonathan Hyer et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.