Department of Neurology (KEG, DRG), The John Hopkins University School of Medicine, Baltimore, Maryland; and Departments of Neurosurgery, Ophthalmology, Otolaryngology-Head and Neck Surgery, Emergency Medicine, and Medicine (DRG), The John Hopkins University School of Medicine, Baltimore, Maryland.
J Neuroophthalmol. 2021 Dec 1;41(4):e672-e678. doi: 10.1097/WNO.0000000000001013.
An ocular tilt reaction (OTR) is a triad of a skew deviation, head tilt, and ocular counter-roll that can be partial or complete. An OTR can occur anywhere along the utriculo-ocular motor pathways from the labyrinth to the interstitial nucleus of Cajal but is almost always central in origin. In acute vestibular neuritis (AVN), case reports have described patients with an OTR due to AVN, although it is unclear whether this examination finding is common or rare.
The vestibular and ocular motor features of 7 patients presenting with AVN are described.
Each of the 7 patients presented with typical features of AVN, including contralesional unidirectional spontaneous nystagmus and an ipsilesional abnormal head impulse test, although each patient also had a complete OTR. None of the patients had vertical diplopia or a skew deviation that was measurable with alternate cover testing (i.e., abnormal "test of skew" according to the Head Impulse, Nystagmus, Test of Skew examination); however, all had a subtle 1 prism diopter hyperphoria that was only measurable with a Maddox rod test.
Seven cases of typical AVN with an OTR are presented, and in the authors' experience, the presence of a subtle OTR is a common feature of AVN in these patients.
眼倾斜反应（OTR）是一种偏斜偏差、头倾斜和眼球反向滚动的三联征，可部分或完全发生。OTR 可发生在从迷路到 Cajal 间质核的前庭眼运动通路上的任何部位，但几乎总是起源于中枢。在急性前庭神经炎（AVN）中，病例报告描述了由于 AVN 而出现 OTR 的患者，尽管尚不清楚这种检查结果是否常见或罕见。
描述了 7 例表现为 AVN 的前庭和眼动特征。
7 例患者均表现出典型的 AVN 特征，包括对侧单向自发性眼球震颤和同侧异常头脉冲试验，但每位患者均出现完全的 OTR。没有患者出现垂直复视或可通过交替遮盖试验测量的偏斜偏差（即根据 Head Impulse、Nystagmus、Test of Skew 检查的“偏斜测试”异常）；然而，所有患者均存在仅用 Maddox 棒试验才能测量到的微妙 1 棱镜度上斜视。
呈现了 7 例典型 AVN 伴 OTR 的病例，根据作者的经验，在这些患者中，存在微妙的 OTR 是 AVN 的常见特征。
