Isolated Skew Deviation

Here’s a very peculiar case of a 63yr male with acute vertical diplopia, more pronounced when looking down which makes him feel dizzy and unstable all the time especially when looking downwards. He came to my office 7 days after the beginning of his symptoms.

The only thing I’ve noticed was skew deviation discovered at cross cover test with the hyperphoria of the right eye and hypophoria of the left eye.

I’ve asked for MRI which disclosed a punktiform lesion at mesencephalon.

Skew Deviation

Skew deviation

Skew deviation
This case is open for discussion.

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