"Round the Houses” sign and apraxia of eyelid opening in a 62-year old man

Bhattacharjee, Shakya; Ng, Kher Lik

doi:10.4103/neuroindia.ni_46_17

Cited by 2 publications

(3 citation statements)

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“…In addition to midbrain atrophy, the degeneration of the burst neurons in the riMLF likely explains the mechanism of early selective slow vertical saccades rather than horizontal saccades, and may also explain the occurrence of the ‘round the houses’ sign [23]. Furthermore, the paramedian pontine reticular construction is mainly responsible for creating horizontal saccades [22, 85, 86].…”

Section: Main Textmentioning

confidence: 99%

“…By prompting a patient to carry out quick eye movements to a moving target between a completely upright and downwards position while keeping the head stationary, a ‘round the houses’ sign can be detected. Eye motion following a curved course (oblique saccades), rather than a straight line, could also be an indication for a ‘round the houses’ sign [85, 86].…”

Section: Main Textmentioning

confidence: 99%

“…Two articles (one commentary and one case report) reporting on ‘round the houses’ signs in patients with PSP were identified [85, 86]. The signs were mentioned by Quinn in an old comment through his experience with several patients with PSP [85].…”

Section: Main Textmentioning

confidence: 99%

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How to spot ocular abnormalities in progressive supranuclear palsy? A practical review

Phokaewvarangkul

Bhidayasiri

2019

Transl Neurodegener

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Background For parkinsonian disorders, progressive supranuclear palsy (PSP) continues to be significant for differential diagnosis. PSP presents a range of ocular abnormalities that have been suggested as optional tools for its early detection, apart from the principal characteristic of postural unsteadiness. Nonetheless, such symptoms may be difficult to identify, particularly during the early onset stage of the disorder. It may also be problematic to recognize these symptoms for general practitioners who lack the required experience or physicians who are not specifically educated and proficient in ophthalmology or neurology. Main body Thus, here, a methodical evaluation was carried out to identify seven oculomotor abnormalities occurring in PSP, comprising square wave jerks, the speed and range of saccades (slow saccades and vertical supranuclear gaze palsy), ‘round the houses’ sign, decreased blink rate, blepharospasm, and apraxia of eyelid opening. Inspections were conducted using direct visual observation. An approach to distinguish these signs during a bedside examination was also established. When presenting in a patient with parkinsonism or dementia, the existence of such ocular abnormalities could increase the risk of PSP. For the distinction between PSP and other parkinsonian disorders, these signs hold significant value for physicians. Conclusion The authors urge all concerned physicians to check for such abnormalities with the naked eye in patients with parkinsonism. This method has advantages, including ease of application, reduced time-consumption, and requirement of minimal resources. It will also help physicians to conduct efficient diagnoses since many patients with PSP could intially present with ocular symptoms in busy outpatient clinics. Electronic supplementary material The online version of this article (10.1186/s40035-019-0160-1) contains supplementary material, which is available to authorized users.

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