Patient is looking straight ahead. 12 seconds: Patient should perform horizontal smooth pursuit with a limited range of eye movements. 40 seconds: Vertical smooth pursuit, severely impaired. 50 seconds: Horizontal saccades, severely impaired. 1 minute 5 seconds: Vertical saccades not possible. 1 minute 20 seconds: Horizontal optokinetic nystagmus, severely impaired. No smooth pursuit eye movements can be induced. 1 minute 50 seconds: Vertical optokinetic nystagmus, severely impaired, no smooth pursuit eye movements and thus also no saccades can be generated. 2 minutes 10 seconds: Vestibulo-ocular reflex: This shows a full range of eye movements driven via the vestibuloocular reflex for horizontal eye movements (2 minutes 26 seconds) and for vertical eye movements. This proves that the lesion is a supranuclear lesion which does not impair the vestibulo-ocular reflex.
Horizontal range of eye movements normal. 20 seconds: Range of vertical eye movements limited upwardly and downwardly (30 seconds). Saccadic smooth pursuit horizontally (50 seconds), vertical eye movements severely impaired, smooth pursuit also severely impaired. 1 minute 25 seconds: Full range of eye movements if they are induced via the vestibulo-ocular reflex vertically. 1 minute 35 seconds: Optokinetic nystagmus, horizontally severely reduced in both directions. 1 minute 52 seconds: Almost no opokinetic nystagmus inducible in the vertical plane either upward or downward. Findings typical of PSP.
Smooth pursuit horizontally shows full range of movements. 10 seconds: Smooth pursuit vertically shows a limitation, in particular for upward gaze. 25 seconds: Head-impulse test to the right, to the left, upward and downward shows a larger range of eye movements, which indicates a supranuclear gaze palsy. Smooth pursuit (50 seconds) is saccadic horizontally and vertically (1 minute) with a limited range of movements. Horizontal saccades (1 minute 25 seconds): moderate slowing of velocity. Vertical saccades (1 minute 45 seconds): severe impairment of vertical saccades with reduced velocity and, in particular upwardly, reduced range of eye movements. All findings are typical of progressive supranuclear palsy.
Cover test shows a fixation deficit with square wave jerks. Examination of the range of eye movements in the horizontal plane (30 seconds) shows severe impairment of the range of horizontal eye movements. More pronounced for vertical eye movements (40 seconds) upwardly and downwardly. 1 minute 15 seconds: Vertical smooth pursuit severely reduced. Horizontal smooth pursuit (1minute 25 seconds) also impaired. Slowing of horizontal saccades (1 minute 40 seconds), more pronounced for vertical saccades (2 minutes). Downward saccades are more impaired than upward saccades (2 minutes 10 seconds). 2 minutes 30 seconds: Optokinetic nystagmus, horizontally not inducible. 2 minutes 50 seconds: Optokinetic nystagmus, vertically also not inducible. VOR testing (3 minutes 30 seconds) via the VOR horizontally and vertically (3 minutes 35 seconds) full range of eye movements can be induced. All findings typical of PSP.