J Korean Neurol Assoc.  1997 Aug;15(4):907-914.

Tonic ocular tilt reaction in the caudal pontine lesions

• Lee PH
• Baik JS
• Han SW
• Sohn YH

Abstract

The ocular tilt reaction (OTR) represents a fundamental pattern of eye hand coordination in roll plane and consists of head tilt, conjugate eye torsion, hypotropia, all toward the same side. OTR can be observed not only in patients with peripheral vestibular dysfucntion but also in these with lesions of the graviceptive pathway, which runs from the vestibular nuclei, crossing the midline at the caudal pons, to the intersititial nucleus of Cajal in the rostral midbrain. We present two patients showed complete OTR with the caudal pontine lesions. The first patient was a 65-year-old woman and the lesions involved the dorsolateral portion of pontomedullary junction and cerebellum which was corn patible with AICA and PICA territorial infarction, a magnetic resonanse image(MRI). The ipsiversive OTR in the first patient might be secondary to the ipsilateral vestibular nuclear lesion. The second patient was a 60 year old man and revealed the infarctions in tegmental portion of caudal pons and cerebellum on MRI. The contraversive OTR in the second patient may be secondary to the pontine tegmental lesion involving medial longitudinal fasciculus which is a structure responsible for ascending crossed contralateral graviceptive pathway. OTR is a sensitive brainstem sign of lateralizing and localizing value and our presenting cases support that OTR represents vestibular tone imbalance in the graviceptive pathways.

MeSH Terms

Aged
Brain Stem
Cerebellum
Female
Hand
Head
Humans
Infarction
Magnetic Resonance Imaging
Mesencephalon
Middle Aged
Pica
Pons
Vestibular Nuclei
Zea mays