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A Paroxysmal Dyskinesia Associated With Elliptical Nystagmus

Hyman E. Rabinovitch, MD; James A. Sharpe, MD; Trevor O. Sylvester, MASc

Arch Ophthalmol. 1977;95(8):1395-1398.

Abstract
• The ocular tilt reaction, a synkinesis of ocular torsion, skew deviation, and head tilting, was a paroxysmal disorder in a patient with multiple sclerosis. In this distinctive pattern of eye and head motion, the 12 o'clock corneal meridians of both eyes are rotated conjugately in the direction of the lower skewed eye and the head is inclined laterally in the same direction. Paroxysmal activation of brain stem otolithic vestibular projections is proposed responsible for the dyskinesia. Coincident attacks of vertical and horizontal low amplitude pendular oscillation of the eyes produced elliptical nystagmus. This ocular motor disorder was treated effectively with carbamazepine.

(Arch Ophthalmol 95:1395-1398, 1977)

Author Affiliations
From the Neuro-Ophthalmology Unit, Division of Neurology, Toronto Western Hospital, and the Department of Medicine, University of Toronto.

Footnotes
Accepted for publication Dec 15, 1976.

Read before the Canadian Congress of Neurological Sciences, Quebec, June 18, 1977.

Reprint requests to Toronto Western Hospital, 399 Bathurst St, Toronto, Ontario M5T 2S8 (Dr Sharpe).

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