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Atrophy of the superior oblique muscle

¹ Specialist Registrar in Clinical Genetics
² Specialist Registrar in Neurology
³ Consultant Neurologist
⁴ Department of Neurology, St George’s Hospital, London, UK

Correspondence to:
Dr F Schon, Department of Neurology, Atkinson Morley Wing, St George’s Hospital, Blackshaw Road, London SW17 0QT, UK; frederick.schon@mayday.nhs.uk

The first 150 words of the full text of this article appear below.

A previously healthy 59-year-old woman presented five years ago with intermittent vertical double vision which soon became continuous, without any other relevant associated history. She noticed the double vision disappeared on tilting her head downwards and to the right (fig 1A). Photographs from when she was younger (fig 1B) confirmed that her head had previously been in a normal position. Neurological examination revealed a resting head tilt to the right, and eye movement examination revealed failure of depression of the adducted left eye consistent with a left superior oblique palsy. Tilting the head to the left (the Bielschowsky head tilt test) exacerbated the vertical separation of the images. She had normal routine blood tests, acetylcholine receptor antibody, CSF examination including oligoclonal bands, ECG and chest x ray. MRI of the brain was normal but orbital MRI showed almost complete atrophy of the left superior oblique muscle . . . [Full text of this article]