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Supranuclear gaze palsy and eyelid apraxia in postencephalitic parkinsonism

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Summary

We describe six patients with clinicopathologically confirmed postencephalitic parkinsonism (PEP) in whom oculomotor abnormalities developed several years after suffering the initial episode of encephalitis lethargica. Four of the cases had vertical supranuclear gaze palsy and two eyelid apraxia, features typically associated with progressive supranuclear palsy (PSP). Our findings indicate that the presence of gaze palsy alone may not be a reliable clinical discriminator between PEP and PSP. Involvement of the dorsal central gray nucleus, nucleus centralis pontis oralis, nucleus dorsal raphe interpositus, rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), nucleus interstitialis of Cajal, nucleus of the posterior commissure, pedunculopontine nuclei and frontal cortex was observed in several of our PEP cases and may contribute to the oculomotor abnormalities in this disorder. Whether the dorsal tegmental nucleus, caudal to the supratrochlear nucleus, severely affected in all our PEP cases, has a role in vertical gaze needs to be further studied.

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Abbreviations

PSP :

progressive supranuclear palsy

NFTs :

neurofibrillary tangles

NPTs :

neuropil threads

riMLF :

rostral interstitial nucleus of the medial longitudinal fasciculus

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  1. I. Litvan

    Present address: Neuroepidemiology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA

Authors and Affiliations

  1. Department of Neurology, University Hospital, Innsbruck

    G. K. Wenning

  2. Ludwig Boltzmann Institute of Clinical Neurobiology, Vienna, Austria

    K. Jellinger

  3. Neuroepidemiology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA

    G. K. Wenning

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  2. K. Jellinger
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Wenning, G.K., Jellinger, K. & Litvan, I. Supranuclear gaze palsy and eyelid apraxia in postencephalitic parkinsonism. J. Neural Transmission 104, 845–865 (1997). https://doi.org/10.1007/BF01285553

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