OCULOMOTOR IMPAIRMENT IN AMYOTROPHIC-LATE RAL-SCLEROSIS - CASE-REPORT

Background Amyotrophic lateral sclerosis (ALS), a neurodegenerative di sorder of unknown origin, was thought to spare the extraocular muscles . Extraocular involvement has recently been reported to occur in the l ate stages of ALS following respiratory insufficiency. Case report We report on two patients with ALS who were referred for screening of ocu lomotor impairment in ALS. Orthoptic examination in a 64-year-old woma n with peripheral ALS revealed retraction of the upper eye lids as wel l as impaired abduction and upgaze in both eyes, developing prior to r espiratory insufficiency. A 50-year-old man with bulbar ALS was found to have bilateral impairment of upgaze as well as a negative Bell's ph enomenon. Horizontal pursuit was interrupted by compensatory saccades, vertical fixating saccades were slightly hypometric. These oculomotor changes were also seen prior to respiratory insufficiency. Conclusion These findings provide further evidence of early oculomotor involveme nt in ALS, e.g. prior to respiratory failure and prior than previously suspected. Oculomotor impairment may occur in both the peripheral and the bulbar type of ALS.