The Ocular Tilt Reaction

Abstract

A patient with ocular motility findings consistent with a right superior oblique palsy was found to have binocular ocular torsion and a head tilt that led to the diagnosis of an ocular tilt reaction. Magnetic resonance imaging disclosed a right pontine lesion presumably involving the descending tract from the interstitial nucleus of Cajal to the contralateral vestibular nucleus. This lesion is located more inferiorly than one would expect in a superior oblique palsy. Physicians should be aware that patients with a vertical deviation and a head tilt might have an ocular tilt reaction, as opposed to a superior oblique palsy.

• ocular tilt reaction
• superior oblique palsy
• skew deviation