This rare disease is caused by chronic systemic infection with the bacterium Tropheryma whipplei and is usually considered a gastrointestinal disorder.
Signs and Symptoms
The symptoms of Whipple’s disease can vary amongst patients but weight loss, diarrhea, joint pain and arthritis are common signs. Neurological symptoms, which only appear after the destruction of brain areas due to long-term infection with the bacterium, are highly diverse and can mimic many other diseases. Ocular motor symptoms include initial vertical gaze palsy, later horizontal gaze palsy and complete ophthalmoplegia. Wihipples disease is an important differential diagnosis for progressive supranuclear palsy (PSP).
A biopsy of the gastrointestinal tract followed by gram-staining of the tissue is used to detect the gram-positive bacilli. In addition immunohistochemical or PCR-based assays are available to detect Tropheryma whipplei in sample tissues.
Observable ocular motor disorders
- Vertical gaze palsy
- Horizontal gaze palsy
- Complete ophthalmoplegia
0.08 Alternating cover test reveals an esophoria. 0.43 Normal range of horizontal eye movements, severely impaired range of vertical eye movements, in particular upward. 1.00 Vertical smooth pursuit impaired, in particular when looking upward. 1.25 Horizontal saccades slow to the right and to the left. 1.35 Vertical saccades, in particular when looking upward, severely impaired with a slight convergence movement. 1.45 Testing of the VOR and eye movements shows that the VOR-driven eye movements are better than the saccades and smooth pursuit.
Strupp M, et al. (2014) Central ocular motor disorders, including gaze palsy and nystagmus. J Neurol 261(2):542-558. PubMed