Whipple’s disease mimicking progressive supranuclear palsy: the diagnostic value of eye movement recording
- aDepartments of Neurology, University Hospitals of Cleveland and Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio 44106, USA, bOhio State University Medical Center, Columbus, Ohio 43210, USA
- Dr Lea Averbuch-Heller, Department of Neurology, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, Ohio 44106–5000, USA. Telephone 001 216 844 3731; fax 001 216 844 3160; email lah2{at}msn.com
- Received 17 June 1998
- Revised 22 September 1998
- Accepted 23 September 1998
Abstract
Treatable causes of parkinsonian syndromes are rare; Whipple’s disease is one of them. A patient is described who presented with a parkinsonian syndrome and abnormal vertical gaze. Measurement of eye movements showed marked slowing of upward saccades, moderate slowing of downward saccades, a full range of voluntary vertical eye movements, curved trajectories of oblique saccades, and absence of square wave jerks. These features, atypical of progressive supranuclear palsy, suggested the diagnosis of Whipple’s disease, which was subsequently confirmed by polymerase chain reaction analysis of intestinal biopsy material. Precise measurement of the dynamic properties of saccadic eye movements in parkinsonian patients may provide a means of identifying treatable disorders.
