Persistent upward eye deviation Report of two cases

Abstract

Two cases of persistent upward eye deviation (PUED), each lasting about one month, are reported. In the first case, no deficit in eye motility was noticed and the ocular deviation appeared only in the upright posture. In the second case the oculomotor disorder, which was independent of the patient's position, was associated with an incomplete paresis of the downward gaze and with a Roth-Bielschowsky syndrome. After a review of all similar cases in the literature, it was concluded that PUED is not necessarily the consequence of a downward gaze palsy but can also represent a primary dystonic disorder of the superogyric eye muscles, probably the result of a change in the neuronal systems which regulate the upright posture. Pued is more frequently associated with a downward gaze palsy. It is suggested that oculomotor disorder may be produced not only by an alteration of the oculovestibular reflexes, but also by an imbalance in the influences controlling the vertical pursuit.