Skew deviation

As Hertwig - Magendie 's syndrome, Hertwig - stomach diesche squint or skew deviation ( engl. skew " wrong," deviation " deviation" ) is a vertical squint of the eyes called, in which the, the other is an even more deeply later. It is named after the German zoologist Richard von Hertwig and the French physiologist François Magendie.

Usually there is also a double-sided, the same disclination ( Zykloversion ), said lower inwardly projecting eye and is rotated outwardly projecting higher. Also alternating forms can occur, in which once the right, at other times the left eye is positioned over the other. The deviation of the two eyes in the vertical plane can in all viewing directions is equal to ( konkomitant ), but also unequal ( inkomitant ) be. In this respect, it is not a Paralytic strabismus. Occur diplopia, which vertically offset and - depending on the extent of the roll sensors ( cyclodeviation ) of the eyes - can also be tilted. In addition, there is a tilt of the patient's subjective vertical, as well as a head tilt. The entire symptom complex is also known as ocular tilt reaction.

Cause is a pränukleäre (above the eye muscle nerve nuclei located ) lesion in the brain stem between the middle and the cerebellum, the area of ​​the peripheral Vestibularisapparates or the bridge. The possible different locations are believed to cause an interruption of the pathways from the Otolithenapparat to the core area of the oculomotor nerve and the trochlear nerve and therefore lead to a vertical strabismus. The combination with additional disorders of eye movements or other neurological functions is typical.

Differential Diagnosis

The Hertwig - Magendie 's syndrome should be distinguished from both the vertical konkomittierenden disorders of strabismus and strabismus sursoadductorius deorsoadductorius, as well as the clinical picture of the dissociated strabismus height.