Professional and Linguistic Assessments Board (PLAB) Practice Exam

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What type of eye movement is preserved in locked-in syndrome?

Horizontal gaze
Upward gaze
Downward gaze
Visual tracking

The correct answer is: Upward gaze

In locked-in syndrome, the individual typically retains the ability to perform upward gaze movements. This condition results from a lesion affecting the ventral part of the pons, leading to paralysis of voluntary muscle movements while leaving the eye movements intact to some extent. The preservation of upward gaze is due to the involvement of specific neural pathways and nuclei that govern eye movement. In particular, the pathways responsible for vertical eye movements, including upward gaze, are often less affected in locked-in syndrome compared to other types of eye movements, such as horizontal gaze. This characteristic can be a means of communication for individuals with the condition, allowing them to signal responses by moving their eyes upwards. Other types of eye movements, such as horizontal gaze and visual tracking, are generally compromised in locked-in syndrome due to the paralysis of the muscles that control these movements. Therefore, the ability to move the eyes upward represents a crucial distinction in the symptomatology of this syndrome.