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HOME > J Korean Bal Soc > Volume 2(1); 2003 > Article
Practical Review Ocular tilt reaction in unilateral cerebellar infarction; a preliminary report

DOI: https://doi.org/
Department of Neurology, College of Medicine, Seoul National University
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Background
Ocular tilt reaction (OTR), which consists of head tilt, ocular torsion, and skew deviation, occurs in lesions involving the utricular pathway from the peripheral labyrinth to the interstitial nucleus of Cajal in the mesodiencephalic junction. However, the effect of cerebellar lesions on OTR remains to be elucidated. Objective: To describe characteristics of OTR in patients with unilateral cerebellar lesions. Methods: Nine patients with acute infarction in the territory of medial branch of the posterior inferior cerebellar artery (mPICA) and two patients with acute superior cerebellar arterial (SCA) infarction were included. All patients received full neuro-otological evaluation. The ocular torsion was measured by using fundus photos. Perceived tilt of the visual vertical was analyzed by using a computerized program.
Results
Patients with acute mPICA and SCA infarctions showed contraversive head tilt (more than 5 degrees) and ocular torsion. Skew deviation was present only in one patient with mPICA infarction. The SVV tilt was also observed in the direction of OTR in all patients tested.
Conclusion
The cerebellum may modulate the signal conveyed in the utricular pathway. The presumed inhibitory control from the ipsilateral nodulus may be released in patients with mPICA infarction. In SCA territory infarction, the contraversive OTR may be caused by concurrent damage to the ipsilesional ascending pathway in the upper midbrain. Alternatively, a stimulatory pathway from the nodulus to the contralateral utricular pathway before decussation may be present and damaged in the superior cerebellum.


Res Vestib Sci : Research in Vestibular Science