Professional and Linguistic Assessments Board (PLAB) Practice Exam

What clinical findings are consistent with decreased vertical eye movements?

1. Cauda equina syndrome

2. Supra nuclear palsy

3. Locked-in syndrome

4. Multiple sclerosis

The correct answer is: Supra nuclear palsy

Decreased vertical eye movements are commonly associated with supranuclear palsy, a condition characterized by progressive degeneration of specific brain areas involved in the control of eye movements, particularly the vertical gaze. In supranuclear palsy, the basal ganglia and brainstem pathways, which are crucial for initiating and coordinating eye movements, are affected. This results in difficulties in moving the eyes upward and downward, leading to a distinct clinical presentation. Patients with this condition may also exhibit other symptoms such as difficulty with balance and gait, slowness in movement, and cognitive decline. These findings align with the clinical picture of Stevens-Johnson syndrome, providing a strong basis for why decreased vertical eye movements are indicative of this diagnosis. The other options present various neurological and systemic conditions but do not primarily feature decreased vertical gaze as a hallmark symptom. Cauda equina syndrome typically affects lower motor neurons and sensory function in the legs. Locked-in syndrome generally preserves vertical eye movements, while multiple sclerosis may lead to a variety of eye movement disorders but is not specifically associated with decreased vertical gaze in the same way as supranuclear palsy.