title: Contraversive ocular tilt reaction after the lateral medullary infarction.
abstract: BACKGROUND
  The triad of ocular tilt reaction (OTR) is conjugated ocular torsion, skewed deviation, and head tilt. A lesion involving below the inferior pons develops ipsiversive OTR, whereas a lesion above the inferior pons leads to contraversive OTR. A lateral medullary infarction usually causes ipsiversive OTR. This is the first report of contraversive OTR following the lateral medullary infarction.
  
  
  METHODS
  A 58-year-old woman was admitted due to sudden-onset vertigo and gait disturbance. A neurological examination revealed OTR to the left side (left head tilt, leftward ocular torsion, and skew deviation). Lateropulsion to the right and dysmetria on the right arm and leg were present. Diffusion-weighted MRI revealed an acute infarction of the right lateral medulla and the posterolateral pons. The patient slowly improved and can walk without sway after 1 week. Neither head tilt nor ataxia was observed after 3 months.
  
  
  CONCLUSIONS
  Lateral medullary lesion typically results in ipsilateral OTR. Contraversive OTR of our patient might be derived from the disruption of the cerebellovestibular inhibitory pathway by the lesion in the juxtarestiform body in the lateral medulla.
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyoo Ho
authors.initials: KH
authors.lastname: Cho
authors.forename: Young Dae
authors.initials: YD
authors.lastname: Kim
authors.forename: Jinkwon
authors.initials: J
authors.lastname: Kim
authors.forename: Byoung Seok
authors.initials: BS
authors.lastname: Ye
authors.forename: Ji Hoe
authors.initials: JH
authors.lastname: Heo
authors.forename: Hyo Suk
authors.initials: HS
authors.lastname: Nam
mesh_terms: D005260:Female; D006801:Humans; D014854:Lateral Medullary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000150:complications / Q000175:diagnosis