title: The influence of body position on Bielschowsky's test.
abstract: OBJECTIVE
  To investigate the veracity of Jampolsky's statement that Bielschowsky's head tilt test is inverted if performed with the patient in the upside-down position and to interpret its neuromuscular mechanism.
  
  
  METHODS
  We present a series of 10 patients selected from a referred sample who were diagnosed with superior oblique paresis. Hypertropia was measured in the primary position, with the head erect and tilted toward both shoulders with the patient in the erect, supine, and upside-down positions. The last position was achieved by hanging the patient upside-down.
  
  
  RESULTS
  As expected, our results showed the veracity of Jampolsky's statement. The forced head tilt difference was inverted or significantly decreased when the test was performed in the upside-down position. Moreover, in all patients, Bielschowsky's phenomenon was neutralized in the supine body position, in which hypertropia with the head erect tended to vanish. In 3 patients, it disappeared completely.
  
  
  CONCLUSIONS
  This study showed that, in patients with superior oblique paresis, differences in the extent of hypertropia in Bielschowsky's test tended to vanish when the test was performed with the patient in the supine position and invert when it was performed with the patient in the upside-down position.
authors: Department of Ophthalmology, Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors: Carlos R
authors: CR
authors: Souza-Dias
authors: Department of Ophthalmology, Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
authors: Mauro
authors: M
authors: Goldchmit
authors: Department of Ophthalmology, Instituto Cema, São Paulo, SP, Brazil.
authors: Fabio P
authors: FP
authors: Moraes
authors: Smith-Kettlewell Eye Research Institute, San Francisco, California, United States of America.
authors: Arthur
authors: A
authors: Jampolsky
mesh_terms: D000328:Adult; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D019416:Head Movements / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009886:Ophthalmoplegia / Q000503:physiopathology*; D011187:Posture / Q000502:physiology*; D015203:Reproducibility of Results; D013285:Strabismus / Q000503:physiopathology*