PDF herunterladen
CC BY-NC-ND 4.0 · Annals of Otology and Neurotology 2020; 3(02): 100-102
DOI: 10.1055/s-0041-1724217
Case Report

Vertical Strabismus and Positive Bielschowsky Head-Tilt Test: Atypical Presentation of a Maxillary Mucocele

Filipe André Correia
1   Serviço de Otorrinolaringologia do Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
2   Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
,
Gustavo Filipe Antunes de Almeida
1   Serviço de Otorrinolaringologia do Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
2   Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
,
Carolina Fernandes Pereira Bruxelas
2   Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
3   Serviço de Oftalmologia do Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
,
Pedro Alberto Batista Brissos de Sousa Escada
1   Serviço de Otorrinolaringologia do Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
2   Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
› Institutsangaben
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Test of skew has become a cornerstone in the approach of a patient with vestibular symptoms but a detected vertical misalignment may be caused by an oculomotor disturbance and not a skew deviation. We report the case of an elderly patient with a 1-month history of dizziness and visual disturbance that revealed on bedside examination a spontaneous left head-tilt and a pathologic alternate cover test, with right eye hypertropia and excyclotorsion, worse with right head-tilt. Dizziness was assumed to have a visual origin with unrecognized binocular diplopia, caused by an acquired right eye superior oblique muscle palsy. However, imaging revealed a right maxillary mucocele that eroded the orbit floor into the orbit. The change of the intraorbital component of the maxillary fluid-filled mass with head-tilt through a dehiscent orbital floor may explain the findings of vertical strabismus and positive Bielschowsky head-tilt test in this case. Endoscopic treatment improved symptoms and findings.

Keywords

vertical strabismus - test of skew - superior oblique muscle palsy - skew deviation - Parks–Bielschowsky test


Publikationsverlauf

Artikel online veröffentlicht:
28. Februar 2021

© 2021. Indian Society of Otology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Newman-Toker DE, Kattah JC, Talkad AV., Wang DZ, Hsieh YH.. H.I.N.T.S. to diagnose stroke in the acute vestibular syndrome-three-step bedside oculomotor exam more sensitive than early MRI DWI Stroke. 2009; 40 (11) 3504-3510
    PubMedGoogle Scholar
  • 2 Parks MM. Isolated cyclovertical muscle palsy. AMA Arch Opthalmol 1958; 60 (06) 1027-1035
    CrossrefPubMedGoogle Scholar
  • 3 Bielschowsky A. Lectures on motor anomalies. XI. Etiology, prognosis, and treatment of ocular paralyses. Am J Ophthalmol 1939; 22 (07) 723-734
    CrossrefGoogle Scholar
  • 4 Manchandia AM, Demer JL. Sensitivity of the three-step test in diagnosis of superior oblique palsy. J AAPOS 2014; 18 (06) 567-571
    CrossrefPubMedGoogle Scholar
  • 5 Wong AMF. Understanding skew deviation and a new clinical test to differentiate it from trochlear nerve palsy. J AAPOS 2010; 14 (01) 61-67
    CrossrefPubMedGoogle Scholar
  • 6 Wong AMF, Colpa L, Chandrakumar M. Ability of an upright-supine test to differentiate skew deviation from other vertical strabismus causes. Arch Ophthalmol 2011; 129 (12) 1570-1575
    CrossrefPubMedGoogle Scholar
  • 7 Lemos J, Subei A, Sousa M. et al. Differentiating acute and subacute vertical strabismus using different head positions during the upright-supine test. JAMA Ophthalmol 2018; 136 (04) 322-328
    CrossrefPubMedGoogle Scholar
  • 8 Brandt T, Dieterich M. Skew deviation with ocular torsion: a vestibular brainstem sign of topographic diagnostic value. Ann Neurol 1993; 33 (05) 528-534
    CrossrefPubMedGoogle Scholar
  • 9 Lin JS, Liu TT, Manes RP, Galvin JA. Superior oblique palsy: a complication of endoscopic sinus surgery. J AAPOS 2015; 19 (02) 180-181
    CrossrefPubMedGoogle Scholar
  • 10 Shapiro S, Schaefer JL, Gupta S, Nguyen J, Kellermeyer B. Isolated inferior rectus muscle entrapment following endoscopic sinus surgery. Case Rep Otolaryngol 2018; 2018: 4620510
    PubMedGoogle Scholar
  • 11 Tamhankar MA, Kim JH, Ying GS, Volpe NJ. Adult hypertropia: a guide to diagnostic evaluation based on review of 300 patients. Eye (Lond) 2011; 25 (01) 91-96
    CrossrefPubMedGoogle Scholar
  • 12 Diora JR, Plager DA. Sudden-onset trochlear nerve palsy: clinical characteristics and treatment implications. J AAPOS 2019; 23 (06) 321.e1-321.e5
    CrossrefPubMedGoogle Scholar