Eye movement problems and differential diagnosis of the parkinsonian syndromes

Richard Armstrong

Research output: Chapter in Book/Report/Conference proceedingChapter (peer-reviewed)

Abstract

Differential clinical diagnosis of the parkinsonian syndromes, viz., Parkinson’s disease (PD), progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA) can be difficult. Eye movement problems, however, are a chronic complication of many of these disorders and may be a useful aid to diagnosis. Hence, the presence in PSP of vertical supranuclear gaze palsy, fixation instability, lid retraction, blepharospasm, and apraxia of eyelid opening and closing is useful in separating PD from PSP. Moreover, atypical features of PSP include slowing of upward saccades, moderate slowing of downward saccades, the presence of a full range of voluntary vertical eye movements, a curved trajectory of oblique saccades, and absence of square-wave jerks. Downgaze palsy is probably the most useful diagnostic clinical symptom of PSP. By contrast, DLB patients are specifically impaired in both reflexive and saccadic execution and in the performance of more complex saccadic eye movement tasks. Problems in convergence in DLB are also followed by akinesia and rigidity. Abnormal ocular fixation may occur in a significant proportion of MSA patients along with excessive square-wave jerks, a mild supranuclear gaze palsy, a gaze-evoked nystagmus, a positioning down-beat nystagmus, mild-moderate saccadic hypometria, impaired smooth pursuit movements, and reduced vestibulo-ocular reflex (VOR) suppression. There may be considerable overlap between the eye movement problems characteristic of the various parkinsonian disorders, but taken together with other signs and symptoms, can be a useful aid in differential diagnosis, especially in the separation of PD and PSP.
Original languageEnglish
Title of host publicationEye movement
Subtitle of host publicationdevelopmental perspectives, dysfunctions and disorders in humans
EditorsLawrence C. Stewart
PublisherNova science
Pages73-92
Number of pages20
ISBN (Electronic)978-1-62808-603-4
ISBN (Print)978-1-62808-601-0
Publication statusPublished - 1 Sep 2013

Fingerprint

Progressive Supranuclear Palsy
Parkinsonian Disorders
Eye Movements
Saccades
Differential Diagnosis
Lewy Body Disease
Paralysis
Multiple System Atrophy
Parkinson Disease
Ocular Fixation
Blepharospasm
Smooth Pursuit
Vestibulo-Ocular Reflex
Apraxias
Eyelids
Signs and Symptoms

Keywords

  • eye movement
  • Parkinsonian disorders
  • differential diagnosis
  • Parkinson's disease
  • dementia with lewy bodies
  • progressive supranuclear palsy
  • multiple system atrophy

Cite this

Armstrong, R. (2013). Eye movement problems and differential diagnosis of the parkinsonian syndromes. In L. C. Stewart (Ed.), Eye movement: developmental perspectives, dysfunctions and disorders in humans (pp. 73-92). Nova science.
Armstrong, Richard. / Eye movement problems and differential diagnosis of the parkinsonian syndromes. Eye movement: developmental perspectives, dysfunctions and disorders in humans. editor / Lawrence C. Stewart. Nova science, 2013. pp. 73-92
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Armstrong, R 2013, Eye movement problems and differential diagnosis of the parkinsonian syndromes. in LC Stewart (ed.), Eye movement: developmental perspectives, dysfunctions and disorders in humans. Nova science, pp. 73-92.

Eye movement problems and differential diagnosis of the parkinsonian syndromes. / Armstrong, Richard.

Eye movement: developmental perspectives, dysfunctions and disorders in humans. ed. / Lawrence C. Stewart. Nova science, 2013. p. 73-92.

Research output: Chapter in Book/Report/Conference proceedingChapter (peer-reviewed)

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Armstrong R. Eye movement problems and differential diagnosis of the parkinsonian syndromes. In Stewart LC, editor, Eye movement: developmental perspectives, dysfunctions and disorders in humans. Nova science. 2013. p. 73-92