Central · refer

Ocular tilt reaction

Skew, head tilt, and ocular counter-roll, all toward one side.

Live · Alternate cover test + head posture
Stylised teaching animation, exaggerated for visibility — not a recording of a real patient, and not a diagnosis.
Localises toCentral
Bedside testAlternate cover test + head posture
Fast phaseVertical refixation

What the animation does not show. The reaction has three components and the animation draws ONE. You are seeing the vertical skew alone — the head tilt and the ocular counter-roll are not rendered, and the eyes carry no torsion here. Read this clip as the skew that the cover test picks up, not as the full ocular tilt reaction, which you assemble from the head posture and the torsion as well.

Reading

A lesion of the graviceptive pathway tilts the eyes and head together: a vertical skew on the cover test, a head tilt toward the lower eye, and conjugate ocular torsion (counter-roll). A lower-brainstem or peripheral lesion tilts toward the lesion side; a midbrain lesion tilts away. The vertical skew is the component the HINTS cover test picks up.

Source: Brandt & Dieterich (ocular tilt reaction); HINTS exam (Kattah 2009).

Practice this in the trainerPlay today’s case

Other signs

Pure downbeat

Positional / primary gaze

Direction-changing (gaze-evoked)

Gaze holding

Head impulse — normal

Head impulse (thrust)
Stylised teaching animations authored by NeuroDash. Not real-patient recordings, not board-certified, and not reviewed by an outside specialist. Educational only — not medical advice and not a diagnosis.