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From the Neurology Department, Wellington Hospital, Wellington, New Zealand (Dr. Mossman), and Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia (Dr. Halmagyi).
Address correspondence and reprint requests to Dr Halmagyi, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Sydney, Australia.
We report on two patients each with tonic, contraversive partial ocular tilt reactions due to unilateral cerebellar lesions: one patient had had a caudal cerebellar hemorrhage, the other a posterior inferior cerebellar artery territory infarct. Both patients had tonic contraversive conjugate ocular torsion; one had skew deviation; neither had a head tilt. One patient had no specific neurologic deficit apart from the conjugate ocular torsion, which was first suspected because of a deviation of the subjective visual horizontal. These observations imply that the ocular tilt reaction (OTR), a brainstem otolith-ocular reflex of probable utricular origin, is under the inhibitory control of the ipsilateral caudal cerebellum, possibly the nodulus, and that a patient with a cerebellar infarct can present with imbalance as the only neurologic symptom and with conjugate ocular torsion as the only specific neurologic sign.
Received October 1, 1996. Accepted in final form February 4, 1997.
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