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Pramod Kumar Pandey, MD; Pankaj Vats, MS, DNB; Anupam Singh, MBBS; Samreen Uppal, MS

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Bhola et al¹ ascribe bilateral superior oblique palsy (SOP) and dorsal midbrain syndrome to midbrain hemorrhage. We offer the following comments on the cause and diagnosis.

Primary position right hypertropia and left hypertropia on head tilt to either side, with no reversal of hypertropia, run counter to a diagnosis of bilateral SOP. A negative head tilt test, acquired comitant esodeviation, oscillopsia, and marked (30°) subjective extorsion suggest an alternate diagnosis of laterally alternating skew deviation with acute acquired comitant esotropia (AACE) due to damage to horizontal and vertical prenuclear vestibulo-ocular reflex (VOR) inputs to ocular motor nuclei. Negative head tilt test and oscillopsia indicating bilateral midbrain stroke, acute hydrocephalus, and surgical trauma from ventriculoperitoneal shunt placement are all present and could be causal.² Diffuse midbrain hemorrhage seems to be a chance finding. As for bilateral symmetrical . . . [Full Text of this Article]

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RELATED ARTICLE

Dorsal Midbrain Syndrome With Bilateral Superior Oblique Palsy Following Brainstem Hemorrhage
Rahul Bhola and Richard J. Olson
Arch Ophthalmol. 2006;124(12):1786-1788.
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