Ocular tilt reaction due to a mesencephalic lesion in juvenile polyarteritis nodosa - 28/08/11
, Christopher M. Harris, PhD c, Michael J. Dillon, FRCP, FRCPCH d, W.Kling Chong, MRCP, FRCR e, J. Elston, BSc, MD, FRCS, FRCOphth f, David S.I. Taylor, DSc, FRCPCH, FRCOphth f, gAbstract |
Purpose |
To describe a case of ocular tilt reaction caused by vasculitic lesions in the midbrain in a child with polyarteritis nodosa.
Design |
Observational case report.
Methods |
A 5-year-old girl with a chronic illness developed diplopia associated with a left head tilt, right hypertropia, torsional nystagmus, slowed vertical saccades and poor convergence. Fundoscopic examination demonstrated conjugate leftward torsion of the eyes consistent with a sustained ocular tilt reaction.
Results |
Renal angiography confirmed polyarteritis nodosa and cerebral magnetic resonance imaging demonstrated mesencephalic pathology.
Conclusions |
Polyarteritis nodosa is a difficult condition to diagnose in a child and can cause brainstem lesions. This rare case of ocular tilt reaction of midbrain origin highlights that a sustained head tilt in a child can be due to brainstem pathology, rather than a fourth nerve palsy.
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Vol 135 - N° 2
P. 249-251 - février 2003 Retour au numéro
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