Neurological Sciences

, Volume 33, Issue 6, pp 1225–1232 | Cite as

Vertical supranuclear gaze palsy in Niemann-Pick type C disease

  • Ettore Salsano
  • Chizoba Umeh
  • Alessandra Rufa
  • Davide Pareyson
  • David S. Zee
Review Article

Abstract

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. VSGP is present in approximately 65 % of the cases and is, with gelastic cataplexy, an important risk indicator for NP-C. VSGP in NP-C is characterized by a paralysis of vertical saccades, especially downward, with the slow vertical eye movement systems (smooth pursuit and the vestibulo-ocular reflex) spared in the early phase of the disease. This dissociation is caused by a selective vulnerability of the neurons in the rostral interstitial nuclei of the medial longitudinal fasciculus (riMLF) in NP-C. Here we discuss VSGP in NP-C and how clinicians can best elicit this sign.

Keywords

Niemann-Pick type C disease Vertical eye movements Vertical ocular motor apraxia Vertical supranuclear gaze palsy 

Abbreviations

III

Third cranial nerve

IV

Fourth cranial nerve (trochlear nerve)

FEF

Frontal eye fields

MLF

Medial longitudinal fascicle

DLPN

Dorsolateral pontine nucleus

DV

Dorsal vermis

IO

Inferior oblique

IR

Inferior rectus

MT

Middle temporal area

MST

Medial superior temporal area

NP-C

Niemann-Pick type C

NRTP

Nucleus reticularis tegmenti pontis

OKN

Optokinetic nystagmus

PEF

Parietal eye fields

PPRF

Paramedian pontine reticular formation

riMLF

Rostral interstitial nuclei of the medial longitudinal fasciculus

SC

Superior colliculi

SCC

Semicircular canals

SO

Superior oblique

SPEM

Smooth pursuit eye movements

SR

Superior rectus

VN

Vestibular nuclei

VOR

Vestibulo-ocular reflex

VPF

Ventral paraflocculus

VSGP

Vertical supranuclear gaze palsy

Notes

Conflict of interest

E. Salsano has been invited in meetings organized and sponsored by Actelion Pharmaceuticals Ltd; David S. Zee teaches in courses sponsored by Sun Pharma and Abbott Pharmaceuticals.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Ettore Salsano
    • 1
  • Chizoba Umeh
    • 2
  • Alessandra Rufa
    • 3
  • Davide Pareyson
    • 1
  • David S. Zee
    • 2
  1. 1.Department of Clinical NeurosciencesFondazione IRCCS Istituto Neurologico Carlo BestaMilanoItaly
  2. 2.Department of NeurologyThe Johns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of Neurological, Neurosurgical and Behavioural SciencesUniversity of SienaSienaItaly

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