Isolated complete gaze palsy: An unusual ocular movement deficit probably due to a bilateral parapontine reticular formation (PPRF) lesion

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Abstract
The unusual finding of an isolated horizontal and vertical gaze palsy characterized the initial episode in a patient suffering from clinically confirmed multiple sclerosis. The localization of the lesion within the parapontine reticular formation (PPRF) bilaterally is based on recent anatomical and physiological information from experiments on monkeys. The ocular dysfunction developed over nine days as follows: (I) complete horizontal gaze paralysis with loss of horizontal optokinetic nystagmus; (2) severe vertical paresis with marked diminution ofsaccadic eye movements but sparing of smooth pursuit movements; (3) abolition of vestibulo-ocular reflexes; and (4) preservation of convergence and pupillomotor activity. Apart from these eye movement defects, neurological and neuropsychological examinations disclosed no abnormalities. The relationship to a few apparently similar case reports in the literature is discussed.