Periodic nonalternating ocular skew deviation accompanied by head tilt and pathologic lid retraction.
A 60-year-old black male with a 13-year history of adult onset diabetes mellitus and hypertension with a previous lacunar stroke suddenly developed a periodic head and eye movement disorder characterized by nonalternating skew deviation, rotatory nystagmus, head tilt, and lid retraction. On CT scan, the patient had a lacunar infarct in the right midbrain in the region of the interstitial nucleus of Cajal, an anatomical area involved with head tilt, torsional eye movement, and skew deviation.
D002544:Cerebral Infarction / Q000150:complications*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D004172:Diplopia / Q000209:etiology*; D005133:Eye Movements; D005141:Eyelid Diseases / Q000209:etiology; D006257:Head; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008636:Mesencephalon / Q000098:blood supply*; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology*; D009759:Nystagmus, Pathologic / Q000209:etiology