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Ocular tilt reaction due to a mesencephalic lesion in juvenile polyarteritis nodosa
Nicola K Ragge1, Christopher M Harris, Michael J Dillon
1Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. Nicky.Ragge@btinternet.com
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.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.