№ 14Neurology13 min read
Topic 14. Gaze disturbances and their localizing significances
1. Big picture
A gaze disturbance means a problem of conjugate eye movement: both eyes are supposed to move together in the same direction, but the patient cannot direct both eyes normally to one side or vertically.
This topic is highly localizing. In the exam, the key is to distinguish:
| Problem | Eye movement pattern | Diplopia? | Main localization |
|---|---|---|---|
| Gaze disturbance | Both eyes fail to move together in one direction | Usually no diplopia | Supranuclear/cortical or brainstem gaze centers |
| Ocular motor palsy | One eye does not move properly → eyes become disconjugate | Usually diplopia | III, IV, VI nucleus/nerve, neu |
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