Eggink H, Brandsma R, van der Hoeven JH, Lange F, de Koning TJ, Tijssen MA. Teaching Video NeuroImages: The "round the houses" sign as a clinical clue for Niemann-Pick disease type C. Neurology. 2016 May 10;86(19):e202.
A 58-year-old man presented with progressive involuntary jerky movements. In addition to a cortical myoclonus, supported by polymyographic evaluation, we saw a “looping” trajectory of the vertical saccades, also referred to as the “round the houses” sign (video on the Neurology® Web site at http://neurology.org/lookup/doi/10.1212/WNL.0000000000002660.)
This sign has been reported as an early indicator of vertical supranuclear gaze palsy in progressive supranuclear palsy. However, vertical supranuclear gaze palsy is not disease specific and in our patient led to the genetically confirmed diagnosis of Niemann-Pick disease type C.2 This shows that the presence of the “round the houses” sign should raise suspicion of a treatable diagnosis of Niemann-Pick disease type C.
[-may perform vertical saccades by performing a lateral arc movement = "round the houses" sign-
In some patients in whom the range of ocular movements are still preserved, the so-called “round the houses” sign can be observed early, denoting a laterally curved trajectory of vertical saccades."]