Ocular tilt reaction, internuclear ophthalmoplegia, and torsional nystagmus following mitral commissurotomy.

Ocular tilt reaction, a type of skew deviation, and unilateral internuclear ophthalmoplegia with torsional nystagmus resulting from an ischemic event may result from unilateral disruption of otolithic pathways in the medial longitudinal fasciculus. A subset of skew deviations is known to simulate superior oblique palsy; however, none have been reported with a coexisting internuclear ophthalmoplegia. The present report documents the rare occurrence of an ocular tilt reaction simulating a left superior oblique palsy from involvement of left medial longitudinal fasciculus at the level of interstitial nucleus of Cajal.