title: Ocular tilt reaction due to a mesencephalic lesion in juvenile polyarteritis nodosa.
abstract: OBJECTIVE
  To describe a case of ocular tilt reaction caused by vasculitic lesions in the midbrain in a child with polyarteritis nodosa.
  
  
  METHODS
  Observational case report.
  
  
  METHODS
  A 5-year-old girl with a chronic illness developed diplopia associated with a left head tilt, right hypertropia, torsional nystagmus, slowed vertical saccades and poor convergence. Fundoscopic examination demonstrated conjugate leftward torsion of the eyes consistent with a sustained ocular tilt reaction.Renal angiography confirmed polyarteritis nodosa and cerebral magnetic resonance imaging demonstrated mesencephalic pathology.
  
  
  CONCLUSIONS
  Polyarteritis nodosa is a difficult condition to diagnose in a child and can cause brainstem lesions. This rare case of ocular tilt reaction of midbrain origin highlights that a sustained head tilt in a child can be due to brainstem pathology, rather than a fourth nerve palsy.
authors.affiliation: Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. Nicky.Ragge@btinternet.com
authors.forename: Nicola K
authors.initials: NK
authors.lastname: Ragge
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Harris
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dillon
authors.forename: W Kling
authors.initials: WK
authors.lastname: Chong
authors.forename: J
authors.initials: J
authors.lastname: Elston
authors.forename: David S I
authors.initials: DS
authors.lastname: Taylor
mesh_terms: D001241:Aspirin / Q000627:therapeutic use; D001927:Brain Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000627:therapeutic use; D004172:Diplopia / Q000188:drug therapy / Q000209:etiology*; D004359:Drug Therapy, Combination; D005260:Female; D019416:Head Movements; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D009759:Nystagmus, Pathologic / Q000188:drug therapy / Q000209:etiology*; D010488:Polyarteritis Nodosa / Q000150:complications* / Q000188:drug therapy; D011239:Prednisolone / Q000627:therapeutic use; D011859:Radiography; D011899:Ranitidine / Q000627:therapeutic use; D012438:Saccades; D013285:Strabismus / Q000188:drug therapy / Q000209:etiology*; D013681:Tegmentum Mesencephali / Q000187:drug effects / Q000473:pathology*
chemical_list: D011899:Ranitidine; D003520:Cyclophosphamide; D011239:Prednisolone; D001241:Aspirin