Clinical Characteristics of Abnormal Postures of the Head and Neck Caused by Unilateral Superior Oblique Palsy

Abstract

Objective: To present the clinical characteristics of abnormal posture of the head and neck (APHN) caused by unilateral superior oblique palsy (USOP) for differential diagnosis of childhood APHN. Method: The medical charts of children who came to Department of Physical Medicine and Rehabilitation, Ajou University Medical Center from 2003 to 2008 for APHN were reviewed with special reference to ocular causes of APHN. Children who showed a positive Bielschowsky’s head tilt test were strongly suspected to have USOP. In-depth ophthalmic evaluations were done after 6 months of age to identify USOP for those children. The clinical characteristics of children with USOP were compared with those of children with congenital muscular torticollis. Results: Sixteen children were diagnosed with APHN related to ocular causes. Seven children out of 16 (43.8%) had APHN secondary to USOP, which was the most common ocular cause of APHN. The initial clinical presentation of 7 children with USOP was contralateral laterocollis toward the shoulder on the non-USOP side at a mean age of 15.57±12.55 months; USOP was diagnosed at a mean age of 19.07±11.29 months. APHN was aggravated by staring at objects, and craniofacial asymmetry was not evident at this age compared to children with congenital muscular torticollis. Conclusion: The clinical characteristics of USOP were presented, which showed laterocollis toward the shoulder of non-USOP. Differential diagnosis of APHN is critical for proper management for APHN and high index of suspicion for USOP by non-ophthalmologic physicians could make earlier diagnosis of USOP possible.