Alternate cover test + head postureCentral · refer
Ocular tilt reaction
Skew, head tilt, and ocular counter-roll, all toward one side.
Alternate cover test + head postureLive
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).
Other signs
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 or a diagnosis.