Chen Chien-Ming, Lin Sung-Hsiung
Section of Neurology, Department of Internal Medicine, Feng Yuan Hospital, Department of Health, Executive Yuan, Taiwan.
Acta Neurol Taiwan. 2006 Mar;15(1):29-33.
The ocular tilt reaction (OTR) consists of skew deviation, ocular torsion and head tilt. A 54-year-old woman developed sudden onset of vertical diplopia. On primary gaze, there was skew deviation with the left eye higher than the right eye. The photography of fundus disclosed 15 degrees of excyclotropia of the right eye and 20 degrees of incyclotropia of the left eye. There was no motor deficit, sensory impairment, ataxia or changes in consciousness. Brain MRI, including T2WI, FLAIR and DWI, revealed two lesions of high signal intensities in bilateral paramedian thalamus, with the much larger and brighter one on the right side. These findings constituted an ipsiversive partial OTR, i.e. skew and torsion toward the side of the lesion. OTR as the only manifestation of paramedian thalamic stroke is rare. A previous report by Dieterich and Brandt indicated that if an OTR occurred in a paramedian thalamic infarct, there should be concurrent ischemia of the interstitial nucleus of Cajal, and it was always contraversive. In contrast, the lesions in our case were quite localized in the paramedian thalamus, not extending into the midbrain. In addition, this report demonstrated an OTR could be ipsiversive under such conditions, opposite to the direction mentioned in previous reports.
眼倾斜反应（OTR）由眼球斜偏、眼球扭转和头部倾斜组成。一名54岁女性突然出现垂直性复视。第一眼位时，存在眼球斜偏，左眼高于右眼。眼底照相显示右眼有15度外旋转斜视，左眼有20度内旋转斜视。无运动功能缺损、感觉障碍、共济失调或意识改变。脑部MRI（包括T2WI、FLAIR和DWI）显示双侧丘脑旁正中存在两个高信号病灶，右侧病灶更大且信号更强。这些表现构成同侧性部分OTR，即向病灶侧的斜偏和扭转。OTR作为丘脑旁正中卒中的唯一表现较为罕见。迪特里希和布兰特之前的一份报告指出，如果在丘脑旁正中梗死中出现OTR，应同时存在 Cajal间质核的缺血，且总是反向的。相比之下，我们病例中的病灶局限于丘脑旁正中，未延伸至中脑。此外，本报告显示在这种情况下OTR可能是同侧性的，与之前报告中提到的方向相反。
