Volume 2, Issue 1 p. 106-106
How Do I?
Free Access

How Do I Examine for a Supranuclear Gaze Palsy?

Tim Anderson FRACP, MD

Corresponding Author

Tim Anderson FRACP, MD

1Christchurch and the New Zealand Brain Research Institute, University of Otago, Christchurch, New Zealand

Correspondence to: Dr. Tim Anderson, Christchurch and the New Zealand Brain Research Institute, University of Otago, 66 Stewart Street, Christchurch 8011, New Zealand; E-mail: [email protected]Search for more papers by this author
First published: 06 December 2014
Citations: 1


Classically, a supranuclear gaze palsy (SNGP) is a conjugate gaze limitation that can be overcome (i.e., corrected) by the vestibulo-ocular reflex (VOR). It involves vertical eye movement most commonly. In practice, SNGP can be encountered as a limitation in excursion of self-generated conjugate saccades (fast eye movements) that can be improved or overcome with verbal command, visual targets, or VOR. Thus, mild SNGPs may be overcome with verbal commands (e.g., “look down”) or visual targets (e.g., “look down at my hand”), whereas moderate SNGPs may be overcome by smooth pursuit mechanisms and following a visual target (e.g., “look at my pen as it moves”) and severe SNGPs can only be overcome with the VOR (i.e., fixating straight ahead while the head is passively rotated). So, it is best to assess for an SNGP in a hierarchical fashion; initially assessing saccades to command, then saccades to visual targets, then smooth pursuit of a target, and finally with the VOR.


Funding Sources and Conflicts of Interest: The author reports no sources of funding and no conflict of interest.

Financial Disclosures for previous 12 months: Grant and research support for T.A. was received from PharmaNet13 Pty Ltd., Clinical Network Services (CNS) Pty Ltd., Massachusetts General Hospital, Upsher Smith Laboratories, CHDI Foundation, and PPD Global Ltd NZ; consultation fees were received from Living Cell Technology; and salary support was received from University of Otago, Anderson Neurology Ltd., and Canterbury District Health Board.