Large Bielschowsky head-tilt phenomenon and inconspicuous vertical deviation in the diagnostic positions in congenital superior oblique palsy

Hiroshi Ohtsuki, Satoshi Hasebe, Reika Kono, Takashi Yamane, Hirotake Fujiwara, Fumio Shiraga

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PURPOSE: To report a case of congenital superior oblique palsy with an unusually large Bielschowsky head-tilt phenomenon (BHP) and disproportional inconspicuous vertical deviation. METHODS: Case report. RESULTS: An 18-year-old woman presented with slight compensatory head tilting and a Bielschowsky head-tilt phenomenon of 50 Δ on left tilting. Magnetic resonance imaging revealed atrophy of the left superior oblique muscle. A Hess screen test showed a slight underaction of the left superior oblique muscle, but neither an obvious overaction of the ipsilateral inferior oblique muscle nor inhibitory palsy of the contralateral superior rectus muscle was found. With a 3-mm recession of the ipsilateral superior rectus muscle, Bielschowsky head-tilt phenomenon decreased to 25 Δ. CONCLUSION: A large Bielschowsky head-tilt phenomenon was possibly caused by an increased gain of the otolith-ocular reflex affecting the vertical rectus muscle. Copyright (C) 2000 Elsevier Science Inc.

Original languageEnglish
Pages (from-to)854-856
Number of pages3
JournalAmerican Journal of Ophthalmology
Issue number6
Publication statusPublished - 2000


ASJC Scopus subject areas

  • Ophthalmology

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