High correlation between ocular tilt reaction and contralateral internuclear ophthalmoplegia in paramedian posterior brainstem lesions

Objectives: The ocular tilt reaction (OTR) is characterized by displacement of the subjective visual vertical (SVV), ocular torsion (OT), and skew deviation (SD); it is most likely caused by lesions of graviceptive pathways (GP). Their anatomical localization within the brainstem is not precisely known, but evidence points to the paramedian posterior tegmental region, next to or within the medial longitudinal fascicle (MLF). Patients with lesions of the MLF regularly present with ipsilateral internuclear ophthalmoplegia (INO). Thus, the aim of the present study was to clarify GP localization by analyzing the cor…