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Related Experiment Videos

Different types of skew deviation.

T H Brandt1, M Dieterich

  • 1Department of Neurology, Klinikum Grosshadern, University of Munich, Germany.

Journal of Neurology, Neurosurgery, and Psychiatry
|June 1, 1991
PubMed
Summary
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Skew deviation, a clinical sign of vertical eye misalignment, can arise from distinct vertical ocular deviations. This study identifies three types of skew deviation linked to ocular tilt reactions, originating from the utricle, medulla, or midbrain.

Area of Science:

  • Neuroscience
  • Ophthalmology
  • Vestibular System

Background:

  • Skew deviation presents clinically as a consistent sign of vertical misalignment.
  • However, underlying mechanisms involve diverse patterns of dysconjugate vertical ocular deviations.

Purpose of the Study:

  • To differentiate and describe three distinct types of skew deviation associated with ocular tilt reactions.
  • To elucidate the specific neuroanatomical origins of these skew deviation types.

Main Methods:

  • Clinical case analysis and review of existing literature.
  • Correlation of observed ocular deviations with specific neuroanatomical lesions or stimulation points.

Main Results:

  • Type 1 (utricle): Bilateral upward ocular deviation with unequal amplitudes (similar to otolith Tullio phenomenon).

Related Experiment Videos

  • Type 2 (dorsolateral medulla oblongata): Unilateral hypertropia with the fellow eye in primary position (hypothesized mechanism in Wallenberg's syndrome).
  • Type 3 (midbrain tegmentum): Simultaneous unilateral hypertropia and hypotropia (observed in midbrain stimulation and clinical cases).

    • Conclusions:

    • Skew deviation is not a monolithic entity but arises from specific neurological pathways.
    • Understanding these distinct types aids in localizing lesions within the vestibular and brainstem pathways.