Supranuclear horizontal gaze palsy
Patient should perform smooth pursuit eye movements to the right and to the left. They are highly restricted. 20 seconds: Patient should perform vertical eye movements. They are limited, in particular for upward gaze with a reduced range of movement. 45: Patient should perform vertical saccades. They are almost normal. 1 minute: Patient should perform horizontal saccades. They are bilaterally severely impaired.
Combined vertical and horizontal gaze palsy indicates a pontine brainstem lesion in the rostral interstitial nucleus of the medial longitudinal fascicle (riMLF) and the ipsilateral paramedian pontine reticular formation (PPRF).