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Localization of lesions causing horizontal gaze palsy

Localization of lesions causing horizontal gaze palsy
Frontal lobe lesions
Defect in generating voluntary saccades
Transient ipsilateral horizontal gaze deviation acutely
Gaze palsy overcome with the oculocephalic (doll's eye) maneuver or caloric stimulation
Epileptogenic lesions in the frontal eye fields
Transient deviation of the eyes and head to the contralateral side
Head and eye movements toward the same side during a seizure
Unilateral parietal lesions
Unilateral or bilateral increased saccade latencies
Hypometria (shortened range) for contralateral saccades
Saccadic slowing
Bilateral parietal lesions
Acquired ocular motor apraxia (inability to generate voluntary movements)
Lesions in the corona radiata adjacent to the genu of the internal capsule
Contralateral selective saccadic palsy
Hemorrhages deep in a cerebral hemisphere, particularly the thalamus
Eye deviation to the side of the hemiparesis ("wrong-way eyes")
Mesencephalic lesions
Paresis of contralateral saccades
Supranuclear contralateral gaze palsies associated with ipsilateral oculomotor palsies
Pontine lesions affecting the abducens nucleus and/or the PPRF
Ipsilateral conjugate gaze palsy
Doll's eye maneuver or cold caloric stimulation usually does not overcome gaze palsy
Bilateral horizontal gaze palsies with bilateral lesions
Modified with permission from: Lee AG, Brazis PW. Clinical Pathways in Neuro-ophthalmology: An Evidence-based Approach, Thieme, New York 1998.
Graphic 52250 Version 3.0

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