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Ocular tilt reaction and anterior inferior cerebellar artery syndrome
  1. H Lee1,3,
  2. S-Y Lee2,
  3. S-R Lee3,
  4. B-R Park4,
  5. R W Baloh5
  1. 1Department of Neurology, Keimyung University School of Medicine, 194 Dongsan dong, Daegu, 700-712, South Korea
  2. 2Department of Ophthalmology, Keimyung University School of Medicine
  3. 3Brain Research Institute, Keimyung University School of Medicine
  4. 4Department of Physiology, Medicine and Hanbang Brain Disease Research Centre, Wonkwang University School of Medicine, Iksan, South Korea
  5. 5Department of Neurology, UCLA School of Medicine, Los Angeles, California, USA
  1. Correspondence to:
 Dr Hyung Lee
 hleedsmc.or.kr

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The ocular tilt reaction (OTR) is an eye-head postural reaction consisting of ipsilateral head and neck tilt, skew deviation, and ocular torsion. OTR indicates either a unilateral peripheral vestibular deficit (inner ear or vestibular nerve) or a unilateral lesion of brain stem pathways from the vestibular nuclei to the interstitial nucleus of Cajal in the rostral midbrain.

The anterior inferior cerebellar artery (AICA) supplies the lateral inferior pontine tegmentum and middle cerebellar peduncle, vestibulocochlear nerve including the root entry zone, inner ear, and anterior inferior cerebellum.1 Although there has been one report of skew deviation owing to an AICA infarction,1 the cardinal features of the OTR have not previously been documented. We describe two patients with AICA infarction, each of whom had ipsiversive OTR—one with complete OTR, the other with skew deviation and tonic ipsiversive ocular torsion.

The first was a 58 year old man with long standing hypertension who presented with sudden vertigo and imbalance. On neurological examination, he had bilateral gaze evoked horizontal nystagmus, left peripheral facial weakness and numbness, dysmetria of the left limbs, and gait ataxia. There was no caloric response on the left side. Pure tone audiometry showed 65 dB …

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Footnotes

  • Competing interests: none declared

  • Patient consent was obtained for publication of figure 1