Bielschowsky's head tilt test

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A test for palsy of the superior oblique muscle caused by damage to the IVth cranial nerve.

Description

Damage to the IVth cranial nerve, or trochlear nerve, may cause a palsy of the superior oblique muscle, resulting in a hypertrophia of the affected eye. People with this condition will experience both a vertical and a torsional diplopia (double vision), and they will compensate for this by tilting the head toward the shoulder of the unaffected eye.

A positive test in oblique muscle palsy:
Tilting head toward weak superior oblique muscle will increase image separation.
Tilting head toward opposite side to weak oblique muscle will decrease image separation.

See also Bielschowsky's squint.

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