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pathological ocular tilt reaction

Samuel M Dresner, Nathan H Kung, Joel R Palko, Jonathan L McJunkin, Joel A Goebel, Gregory P Van Stavern
Skew deviation is a rare side effect of intratympanic gentamicin injection for intractable Meniere's disease. When the skew deviation is accompanied by pathologic head tilt and ocular torsion, the result is an ocular tilt reaction (OTR). The authors report the case of a 56-year-old man with refractory Meniere's disease who developed binocular vertical diplopia following intratympanic gentamicin injection and was found to have skew deviation and a partial ocular tilt reaction. The authors also review the reported cases of skew deviation following intratympanic gentamicin and confirm this phenomenon, which has only rarely been reported in the literature...
October 2017: Neuro-ophthalmology
Katarina Ivana Tudor, Damir Petravić, Anđela Jukić, Zlatko Juratovac
OBJECTIVE: To present a patient with a sudden onset ocular tilt reaction (OTR) and review recent knowledge and evolving insights of the underlying pathophysiological mechanisms of skew deviation and OTR. METHODS: A middle-aged hypertensive man who had previously suffered stroke with good recovery presented with sudden-onset double vision, slurred speech, ataxia, and a head tilt. Romberg test was positive. The patient denied having disturbances of visual acuity, eye pain, or recent trauma...
2017: Seminars in Ophthalmology
François Thommen, François-Xavier Borruat
No abstract text is available yet for this article.
June 2, 2015: Neurology
Bik Ling Man, Yat Pang Fu
No abstract text is available yet for this article.
November 28, 2014: BMJ Case Reports
Bik Ling Man, Yat Pang Fu
No abstract text is available yet for this article.
2014: BMJ Case Reports
Roberto Bassani, Stefania Bianchi Marzoli
A 43-year-old woman experienced a worsening of her usual headache. As a right hemifacial hypoesthesia had appeared, the patient underwent a brain MRI that revealed a giant cavernoma localized at the left meso-diencephalic region (figure, A and B). After the operation, an involuntary ocular oscillation known as see-saw nystagmus developed (video on the Neurology® Web site at See-saw nystagmus consists of alternating phases of intorsion of the elevating eye and extorsion of the descending eye...
November 19, 2013: Neurology
Young Eun Huh, Ja-Won Koo, Hyung Lee, Ji-Soo Kim
OBJECTIVE: To determine the patterns and diagnostic value of head-shaking nystagmus (HSN) in patients with acute audiovestibular loss. METHOD: Eighteen patients underwent evaluation of spontaneous nystagmus, gaze-evoked nystagmus, HSN, head impulse test, ocular tilt reaction, subjective visual vertical, bithermal caloric tests, and pure-tone audiogram. The findings were compared with those of 21 patients with labyrinthitis. RESULTS: Fifteen patients (83%) exhibited HSN, and the horizontal HSN usually beat contralesionally (10/14, 71%)...
2013: Audiology & Neuro-otology
P K Pandey, Anupam Singh, Barun Kumar, Shagun Sood, Sanjeev Kumar, Ekta Kumari, Meenakshi Chandel
Ocular tilt reaction, a type of skew deviation, and unilateral internuclear ophthalmoplegia with torsional nystagmus resulting from an ischemic event may result from unilateral disruption of otolithic pathways in the medial longitudinal fasciculus. A subset of skew deviations is known to simulate superior oblique palsy; however, none have been reported with a coexisting internuclear ophthalmoplegia. The present report documents the rare occurrence of an ocular tilt reaction simulating a left superior oblique palsy from involvement of left medial longitudinal fasciculus at the level of interstitial nucleus of Cajal...
October 2012: Journal of AAPOS: the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
P E Gallenga, Giampiero Neri, Ruggero D'Anastasio, Vito Enrico Pettorrossi, Emilio Alfieri, Luigi Capasso
Charged by the Pope Julius II for painting the Cappella Sistina in Rome (between 1508 and 1512), Michelangelo worked in an elevated scaffolding, in an anomalous position with dyes (including poisoning lead salts) and solvents (such as toxic turpentine) dripping on his face and continuously inhaling, in a dim environment illuminated only with oil lamps and candles, as he described himself and sketched in a sonet addressed to Giovanni da Pistoia. In 1510 he began suffering from eye disease: the main symptom was the necessity to elevate the document he was reading up to the level of his eyes...
June 2012: Medical Hypotheses
Seong-Hae Jeong, Eung Kyu Kim, Jun Lee, Kwang-Dong Choi, Ji Soo Kim
To explore the patterns and mechanisms of jerky seesaw nystagmus in internuclear ophthalmoplegia (INO), we analyzed the nystagmus patterns in 33 patients with dissociated torsional-vertical nystagmus and INO. In 11 (33%) patients, the nystagmus was ipsiversive torsional in both eyes with vertical components in the opposite directions. In contrast, 18 (55%) patients showed ipsiversive torsional nystagmus with a larger upbeat component in the contralesional eye. Four (12%) patients exhibited ipsiversive torsional nystagmus with a greater downbeat component in the ipsilesional eye...
September 2011: Annals of the New York Academy of Sciences
Diego Kaski, R Davies, L Luxon, A M Bronstein, P Rudge
The Tullio phenomenon refers to sound-induced disequilibrium or oscillopsia. Patients with this condition frequently present to neurologists, many of whom are unfamiliar with the condition and its diagnostic criteria. Indeed, due to the unusual nature of the symptoms patients are often misdiagnosed as having psychiatric disturbances. Tullio patients describe disequilibrium, auditory and visual symptoms, which are recurrent, brief, and often triggered by loud noises or middle ear pressure changes, e.g. the Valsalva manoeuvre...
January 2012: Journal of Neurology
Vallabh E Das, R John Leigh, Michelle Swann, Matthew J Thurtell
Hemi-seesaw nystagmus (hemi-SSN) is a jerk-waveform nystagmus with conjugate torsional and disjunctive vertical components. Halmagyi et al. in Brain 117(Pt 4):789-803 (1994), reported hemi-SSN in patients with unilateral lesions in the vicinity of the Interstitial Nucleus of Cajal (INC) and suggested that an imbalance in projections from the vestibular nuclei to the INC was the source of the nystagmus. However, this hypothesis was called into question by Helmchen et al. in Exp Brain Res 119(4):436-452 (1998), who inactivated INC in monkeys with muscimol (a GABA(A) agonist) and induced failure of vertical gaze-holding (neural integrator) function but not hemi-SSN...
September 2010: Experimental Brain Research. Experimentelle Hirnforschung. Expérimentation Cérébrale
G M Halmagyi, K P Weber, I S Curthoys
PURPOSE: To review the extent and mechanism of the recovery of vestibular function after sudden, isolated, spontaneous, unilateral loss of most or all peripheral vestibular function - usually called acute vestibular neuritis. METHODS: Critical review of published literature and personal experience. RESULTS: The symptoms and signs of acute vestibular neuritis are vertigo, vomiting, nystagmus with ipsiversive slow-phases, ipsiversive lateropulsion and ocular tilt reaction (the static symptoms) and impairment of vestibulo-ocular reflexes from the ipsilesional semicircular canals on impulsive testing (the dynamic symptoms)...
2010: Restorative Neurology and Neuroscience
María Soledad Boleas-Aguirre, François Chiron
Ocular tilt reaction (OTR) includes skew deviation, eye torsion and head tilt. It is usually accompanied by a tilt in the subjective visual vertical. OTR seems to reflect an otolithic dysfunction. This case report shows an OTR of central origin as a result of simultaneous paramedial thalamic and mesencephalon rostral infarcts.
November 2009: Acta Otorrinolaringológica Española
Jennifer Highsmith, Michael A Crognale
PURPOSE: Intra-ocular pressure (IOP) increases to double that of its normal level under full-body inversion, in part simulating high IOPs found in glaucoma and ocular hypertension. Inversion also simulates negative g-forces experienced in aerobatic maneuvers such as those produced during aerial combat. Studies using achromatic pattern-reversal visual evoked potentials (VEPs) have shown losses in response amplitude when subjects are inverted and IOP is increased. In other studies, chromatic, pattern-onset VEPs have been shown to be a sensitive and objective indicator of ocular and systemic pathology...
August 2009: Documenta Ophthalmologica. Advances in Ophthalmology
Soo-Young Choi, Dae-Hyun Kim, Ji-Hee Lee, Jei Kim
Internuclear ophthalmoplegia (INO) is a complex ocular motility disorder caused by damage to the medial longitudinal fasciculus. The occurrence of hemi-seesaw nystagmus in an INO patient has been reported rarely. This nystagmus may be caused by damage to the pathway from the contralateral vertical semicircular canal. The ocular tilt reaction is characterized by ipsilateral head and neck tilt, skew deviation, and ocular torsion. We report a patient who presented with hemi-seesaw nystagmus, ocular tilt reaction, and limb ataxia combined with an INO from a right focal pontine infarction...
March 2009: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Sun-Young Oh, Kwang-Dong Choi, Byoung-Soo Shin, Man-Wook Seo, Young Hyun Kim, Ji Soo Kim
BACKGROUND: To elucidate the mechanisms of paroxysmal ocular tilt reaction (OTR) from mesodiencephalic lesions by analyzing the associated ocular motor findings. METHODS: Two patients with paroxysmal ipsiversive OTR due to mesodiencephalic lesions underwent evaluation of associated ocular motor abnormalities and one of them had three-dimensional recording of eye motion. We also reviewed previously reported six patients with paroxysmal OTR. RESULTS: One patient showed contraversive torsional nystagmus during the paroxysms in association with vertical gaze limitation and vertical gaze-evoked nystagmus, which are consistent with baseline dysfunction and paroxysmal irritation of the interstitial nucleus of Cajal (INC) during the attacks...
February 15, 2009: Journal of the Neurological Sciences
Henryk Kaźmierczak
The aim of the study was evaluation of central vestibular disorders in the scope of vestibular ocular reflexes disturbances in three planes: roll, pitch and yaw. The topo-diagnostic value of ocular tilt reaction, vertical nystagmus, rotational and horizontal nystagmus in central lesions was discussed.
September 2005: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
J Soo Kim, K-D Choi, S-Y Oh, S-H Park, M-K Han, B-W Yoon, J-K Roh
In 20 consecutive patients with isolated medial medullary infarction, abnormal ocular motor findings included nystagmus (n = 8), ocular contrapulsion (n = 5), and contralesional ocular tilt reaction (n = 2). The nystagmus was ipsilesional (n = 4), gaze-evoked (n = 5), upbeating (n = 4), and hemiseesaw (n = 1). The ocular motor abnormalities may be explained by involvements of the nucleus prepositus hypoglossi, medial longitudinal fasciculus or efferent fibers from the vestibular nuclei, climbing fibers, and cells of the paramedian tracts...
October 25, 2005: Neurology
Nicola K Ragge, Christopher M Harris, Michael J Dillon, W Kling Chong, J Elston, David S I Taylor
PURPOSE: To describe a case of ocular tilt reaction caused by vasculitic lesions in the midbrain in a child with polyarteritis nodosa. DESIGN: 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...
February 2003: American Journal of Ophthalmology
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