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Presentation type	E-poster
Title	Ocular contrapulsion in a patient with lateral medullary syndrome

Purpose	Ocular lateropulsion, a compelling deviation of the eyes to one side without limitation of ocular motor range, is most commonly seen with lateral medullary syndrome (LMS). In these patients, the deviation is typically toward the lesion (ipsipulsion). This is caused by disruption of the olivocerebellar pathway at the level of the lateral medulla. However, if this disruption occurs before these fibers cross the midline, the result would be ocular contrapulsion, more typically associated with medial medullary syndrome.
Methods	Case report.
Results	A 63-year-old man with a history of recovered left lateral medullary infarction 8 years before presented with new symptoms of head torticollis and eye misalignment without diplopia. He also had new episodes of vertigo, hiccups and paresthesia of the right arm and left hemiface, reminiscent of a recurrence of LMS. Examination confirmed torticollis with left head turn. Eye motility was full, though left gaze was effortful on both pursuit and saccades. Ocular lateropulsion was observed, with the eyes deviating to the right under closed lids, along with saccadic dysmetria of vertical saccades deviating to the right. MRI-imaging showed the known left LMI, but no new lesion. Review of previous angio-CT images showed a narrow caliber of the left vertebral artery with very irregular opacification suggestive of multiple atheromatous plaques. Therefore, clinical worsening was probably caused by new (transient) ischemia of the previously injured left lateral medullary region.
Conclusion	While ocular ipsipulsion is an established clinical feature of LMS, ocular contrapulsion may also occur.
Conflict of interest	No

Authors 1

Last name	SEDER
Initials	A
Department	CHU St-Pierre, Ophthalmology
City	Brussels

Authors 2

Last name	NGADI
Initials	M
Department	CHU St-Pierre, Radiology
City	Brussels

Authors 3

Last name	BUELENS
Initials	T
Department	CHU St-Pierre, Ophthalmology
City	Brussels