Botulinum toxin treatment of Hertwig-Magendie sign

Hypertropia, not due to the usual causes and associated with a central nervous system disorder, should be suspected as being a skew deviation (Hertwig-Magendie sign). We describe a new case of this supranuclear disorder, presumably related to cocaine-induced stroke. This disorder was treated by botulinum A toxin (Oculinum) injection into the superior rectus muscle. Follow-up one year later found the vertical deviation resolved.