Ocular Tilt Reaction
The ocular tilt reaction is a postural synkinesis consisting of the triad of:
- Ocular torsion
- Lateral head tilt to the same side
- Skew deviation with hypotropia ipsilateral to the direction of head/eye torsion
The ocular tilt reaction (OTR) is due to disordered function of one utricle or its brainstem connections (vestibular nerve, vestibular nuclei, medial longitudinal fasciculus, interstitial nucleus of Cajal), hence a brainstem otolith-ocular reflex. It has occasionally been reported with cerebellar lesions, and may be under inhibitory cerebellar control. OTR may be tonic, as in the lateral medullary syndrome, or paroxysmal, as in multiple sclerosis.
Halmagyi GM, Curthoys IS, Brandt T, Dieterich M. Ocular tilt reaction: clinical sign of vestibular lesion. Acta OtolaryngolicaSupplementum 1991; 481: 47-50