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Contraversive ocular tilt reaction after the lateral medullary infarction

 Cho, Kyoo Ho  ;  Kim, Young Dae  ;  Kim, Jinkwon  ;  Ye, Byoung Seok  ;  Heo, Ji Hoe  ;  Nam, Hyo Suk 
 NEUROLOGIST, Vol.19(3) : 79-81, 2015 
Journal Title
Issue Date
Female ; Humans ; Lateral Medullary Syndrome/complications ; Lateral Medullary Syndrome/diagnosis* ; Lateral Medullary Syndrome/pathology ; Middle Aged ; Ocular Motility Disorders/complications ; Ocular Motility Disorders/diagnosis
ocular tilt reaction ; medulla ; cerebral infarction
INTRODUCTION: 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. CASE REPORT: 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.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Kim, Jinkwon(김진권) ORCID logo https://orcid.org/0000-0003-0156-9736
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Ye, Byoung Seok(예병석) ORCID logo https://orcid.org/0000-0003-0187-8440
Cho, Kyoo Ho(조규호) ORCID logo https://orcid.org/0000-0003-2402-7198
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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