Partial ocular tilt reaction due to unilateral cerebellar lesion.
We report on two patients each with tonic, contraversive partial ocular tilt reactions due to unilateral cerebellar lesions: one patient had had a caudal cerebellar hemorrhage, the other a posterior inferior cerebellar artery territory infarct. Both patients had tonic contraversive conjugate ocular torsion; one had skew deviation; neither had a head tilt. One patient had no specific neurologic deficit apart from the conjugate ocular torsion, which was first suspected because of a deviation of the subjective visual horizontal. These observations imply that the ocular tilt reaction (OTR), a brainstem otolith-ocular reflex of probable utricular origin, is under the inhibitory control of the ipsilateral caudal cerebellum, possibly the nodulus, and that a patient with a cerebellar infarct can present with imbalance as the only neurologic symptom and with conjugate ocular torsion as the only specific neurologic sign.
Mossman
S
S
Neurology Department, Wellington Hospital, New Zealand.
Halmagyi
G M
GM
D000368:Aged; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000503:physiopathology*; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000503:physiopathology*; D005123:Eye / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D005654:Fundus Oculi; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010296:Parietal Lobe; D014057:Tomography, X-Ray Computed