Vestibular stimulation for supranuclear gaze palsy: case report.
Gaze palsies following severe destruction or irritative lesions of the cerebral hemispheres are rare. This report describes a patient with supranuclear ophthalmoplegia secondary to stroke which was rapidly resolved by cold caloric vestibular stimulation. The patient had a severe infarction of the right cerebral hemisphere and had a fixed deviated gaze to the right 3 months after onset. Cold caloric vestibular stimulation was used in an attempt to evaluate brain stem integrity. Following three successive injections of cold water at OC-5C into the external auditory canal, the patient regained full voluntary extraocular eye movements. The improvement continued for more than 12 months after the last treatment. A literature review of the neuroanatomy and neurophysiology of voluntary and reflex ocular movements is presented. A possible explanation for the improvement in this case is that vestibular input inhibits the tonic phase of antagonistic extraocular muscles while facilitating agonistic extraocular muscles.
D002150:Caloric Tests; D002561:Cerebrovascular Disorders / Q000150:complications; D017679:Cryotherapy; D005133:Eye Movements; D005260:Female; D006801:Humans; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000294:innervation; D009886:Ophthalmoplegia / Q000209:etiology / Q000534:rehabilitation*; D014724:Vestibular Function Tests