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Presentation type	E-poster
Title	Ocular torsional deviation in a unilateral paramedian thalamo-mesencephalic infarction

Purpose	Torsional deviation during vertical saccades has been associated with lesions of the midbrain riMLF. Similar to the ocular lateropulsion (with conjugate horizontal deviation of the eyes upon eye closure and saccadic dysmetria) that is a well-known finding in lateral medullary syndrome, we present an equivalent form of “torsional pulsion” with torsional deviation observed upon eye closure as well as during voluntary eye movements, best appreciated during horizontal and vertical saccades.
Methods	Case report.
Results	A 73-year-old man presented with binocular vertical diplopia. Ocular examination revealed a complete ocular tilt reaction with with head tilt towards the (hypotrophic) left eye and (contraversive) skew deviation with incyclotorsion of the hypertrophic right eye and excyclotorsion of the hypotrophic left eye. There was no spontaneous or gaze-evoked nystagmus but voluntary saccades and smooth pursuit were torsionally deviated to the left (counterclockwise from the patient's point of view), with the eyes slowly returning to the torsional null position after eye movements. The same phenomenon was also observed upon eye closure. Cerebral MRI revealed a semi-recent right paramedian thalamic infarct extending to the rostral midbrain.
Conclusion	Ocular torsional deviation in patients presenting with diplopia could be indicative of a central lesion in the mesodiencephalic region requiring appropriate work-up.
Conflict of interest	No

Authors 1

Last name	MISSA
Initials	E
Department	ULB - CHU Saint Pierre
City	Bruxelles

Authors 2

Last name	WANG
Initials	Z
Department	ULB - CHU Saint Pierre
City	Bruxelles

Authors 3

Last name	Topciu
Initials	M-F
Department	ULB - CHU Saint Pierre

Authors 4

Last name	Buelens
Initials	T
Department	ULB - CHU Saint Pierre
City	Bruxelles