Evaluation of the Bielschowsky Head-Tilt Test

Levine, Morris H.

doi:10.1001/archopht.1969.00990020435002

Cited by 18 publications

(3 citation statements)

References 5 publications

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“…Wegen des Kopfneigephänomens ist bei einseitiger Trochlearisparese zum Ausgleich der Zyklovertikaldeviation eine Neigung des Kopfes zur Gegenseite vorteilhaft (zusätzlich zu einer Senkung und Drehung des Kopfes). Das Kopfneigephänomen ist aber nicht, wie früher angenommen, ein spezifischer Indikator für die Lähmung eines schrägen Augenmuskels [11,17,27,31].…”

Section: Introductionunclassified

Das Kopfneigephänomen bei einseitigen und beidseitig symmetrischen Trochlearisparesen

Gräf

Krzizok²,

Kaufmann³

2005

Klin Monatsbl Augenheilkd

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The head-tilt phenomenon is smaller in long-standing bilateral symmetric superior oblique palsies than in long-standing unilateral superior oblique palsy. This finding supports the hypothesis that in unilateral superior oblique palsy, an adaptive mechanism augments the head-tilt phenomenon by an amplification of the otolith reflex. However, we presume that the amplification of the otolith reflex is only a side effect of the adaptive change of the vertical fusional vergence tonus and thus the price of the improved vertical fusion, rather than a compensatory mechanism.

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Section: Introductionunclassified

Das Kopfneigephänomen bei einseitigen und beidseitig symmetrischen Trochlearisparesen

Gräf

Krzizok²,

Kaufmann³

2005

Klin Monatsbl Augenheilkd

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“…We have no explanation for the fact that the 3-step test chose an oblique muscle in 27 of 28 cases (96%) in which it was diagnostic, while fielding out was much more evenly divided between obliques (16 of 28 or 57%) and vertical recti (12 of 28 or 43%). Levine (1969) O n e possible explanation set forth by proponents of the 3-step test to explain this discrepancy is 'overspread ofcomitance'. This assumes that the 3-step test is the true diagnostic method.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of an Isolated Vertical Muscle Palsy

Getman

Goldstein

1983

Acta Ophthalmologica

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T h e determination of a paretic vertical muscle may be made by prism cover test measurements in the 9 diagnostic positions of gaze or the 3-step test which relies on the Bielschowsky head tilt test. A series of cases with an isolated paretic vertical muscle was used to compare the 2 methods of examination. It was found that 1) the 3-step test (based o n the Bielschowsky head tilt test) is non-diagnostic as frequently as fielding out, 2) the 3-step test is much more likely to diagnose an oblique (especially the superior oblique) than any other muscle, 3) there is a statistically significant association between a loger duration of the paresis and the appearance of spread of comitance, and 4) the disagreement between the 3-step test and cardinal gaze measurements which occurs in 18% of cases can not be adequately explained by 'overspread of comitance' to the point where the deviation is maximum in the opposite field of gaze. T h e measurement of the deviation in the cardinal positions of gaze was felt to more accurately indicate the paretic muscle when the two tests were in conflict.K q ulord,s: Bielschowsky head tilt test -overspread of comitance -the 3-step test -vertical muscle palsy.The problem of diagnosing a paretic ocular cyclovertical muscle has always been difficult. As early as 1889, Duane (1889, 1914, 1919) popularized the 'screen test' because of its accuracy and convenience. The modern equivalent consists of the prism cover test in the 9 cardinal positions of gaze. The position of maximum vertical deviation indicates the paretic muscle.

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“…For Locke (1967) and Levine (1969Levine ( , 1972) the upshoot of the globe during Bielschowsky's head tilting is due to the action of the inferior oblique: this means involvement of the contralateral superior rectus instead of pointing to disturbed ipsilateral torsion. Leese-screen: this diagnostic instrumental method confirms the Parks' three step test.…”

Section: Symptomatologymentioning

confidence: 99%

The superior oblique: A challenging extraocular muscle

Neetens¹,

Janssens²

1979

Doc Ophthalmol

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Isolated paralysis of one or both superior oblique muscles in a consecutive series of 43 patients was found to occur most often by indirect injury to the skull. The etiology in the group of spontaneous cases was mostly vascular. With rare exceptions the latter recovered spontaneously. Those with traumatic palsy may be due to "contrecoup" trauma at the decussation of the nerves or by decompensation of the cerebral fusional mechanism, with dissociation of the images of the two eyes and subsequent vertical deviation. The traumatic cases never recover spontaneously and recession or myectomy of the ipsilateral inferior oblique with or without recession of the contralateral inferior rectus is recommended but only in cases of more than 8 diopters squint, and in cases which do not adapt themselves by minor head-tilting.

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Evaluation of the Bielschowsky Head-Tilt Test

Cited by 18 publications

References 5 publications

Das Kopfneigephänomen bei einseitigen und beidseitig symmetrischen Trochlearisparesen

Das Kopfneigephänomen bei einseitigen und beidseitig symmetrischen Trochlearisparesen

Diagnosis of an Isolated Vertical Muscle Palsy

The superior oblique: A challenging extraocular muscle

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