Ocular Torsion and Tilt of Subjective Visual Vertical and Head in Patients with Acute Brainstem Stroke

J Korean Neurol Assoc > Volume 16(1); 1998 > Article

Journal of the Korean Neurological Association 1998;16(1): 15-20.

급성 뇌간 뇌졸중환자에서 안구회선과 Subjective visual vertical과 고개의 기울어짐

조성은, 박정혁, 정경천, 장대일

경희대학교 의과대학 신경과학교실

Ocular Torsion and Tilt of Subjective Visual Vertical and Head in Patients with Acute Brainstem Stroke

Sung-Eun Cho, M.D., Jeong-Hyuk Park, M. D., Kyung-Cheon Chung, M.D., Dae-il Chang, M.D.

Department of Neurology, Kyung-Hee University, College of Medicine , Korea

Abstract

Background & Purpose : The ocular torsion (OT) and tilt of the subjective visual vertical (SVV) are sensitive brainstem signs and helps us to localize lesion. We calibrated the degree of OT, SVV tilt and head tilt to investigate their characteristics and temporal profiles in patients with brainstem lesion. Methods : We selected 15 patients with acute brainstem stroke. We took serial fundus photographs and body pictures in upright position at various times after the stroke. We also determined the deviations of patient's SVV. The data measurement for this investigation ranged from day 2 to day 47. Results : Eight of ten patients with lateral medullay infarction showed ipsiversive tilt of SVV and OT. Among four patients with pontine infarction, one showed ipsiversive tilt and three contraversive. One patient with midbrain hemorrhage showed cotraversive tilt. The resolution of OT and the tilt of SVV in medullary lesions occurred over the periods ranging from 7 days to more than 47 days and was slower in patients with upper brainstem lesion than lower brainstem lesion. The directions of head tilt in our patients, especially with medullary lesions, were rather different from the previous reports. Conclusion : The vestibular dysfunction by the brainstem lesions disturbs the eye and head stabilization and also distorts the perception of the subjective vertical in space. The direction of OT and the tilt of SVV is ipsiversive in lower brainstem lesion and contraversive in upper brainstem lesion. But head tilt is contraversive in most lower brainstem lesion as well as upper brainstem lesion. Large-grouped study for the direction of head tilt is thought to be needed. These signs are compensated in the course of clinical recovery. Key Words; Ocular torsion, Subjective visual vertical, Head tilt