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A b n o r m a l H e a d P o s i t i o n A b n o r m a l H e a d P o s i t i o n Eric A. Lichtenstein, MD FAAP Eric A. Lichtenstein, MD FAAP

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Page 1: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Abnormal Head PositionAbnormal Head Position

Eric A. Lichtenstein, MD FAAPEric A. Lichtenstein, MD FAAP

Page 2: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

tortustortus twistedtwistedcollumcollum neckneck

TorticollisTorticollis

Page 3: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

TiltTilt

Head tiltHead tilt

Page 4: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

TurnTurn

Face turnFace turn

Page 5: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Chin upChin up

Page 6: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Chin downChin down

Page 7: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Abnormal Head Position (AHP)Abnormal Head Position (AHP)

TiltTilt headhead

TurnTurn faceface

ChinChin up/downup/down

Page 8: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Ocular AHPOcular AHP

adaptive mechanismadaptive mechanism

neck control required neck control required

Page 9: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Ocular AHP: AdaptationOcular AHP: Adaptation

Strabismus Strabismus (avoid double)(avoid double)

Ptosis Ptosis (seek stereo)(seek stereo)

Nystagmus Nystagmus (improve acuity)(improve acuity)

Page 10: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Ocular AHPOcular AHP

Double vision Double vision (strabismus)(strabismus)

Stereo acuity Stereo acuity (ptosis)(ptosis)

Visual acuity Visual acuity (nystagmus)(nystagmus)

Not issues during sleep Not issues during sleep

Page 11: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

AHP HxAHP Hx

Does AHP persist with sleep?Does AHP persist with sleep?Ocular: noOcular: no

How old when AHP began?How old when AHP began?Ocular: 3 to 4 monthsOcular: 3 to 4 months

Page 12: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

AHP d/dxAHP d/dx

•• Muscular/skeletalMuscular/skeletal

•• AuditoryAuditory

•• Ocular Ocular

Page 13: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Ocular AHPOcular AHP

Straighten the headStraighten the headStrabismus?Strabismus?

Ptosis?Ptosis?Nystagmus?Nystagmus?

Page 14: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Ocular AHPOcular AHP

Strabismus Strabismus

PtosisPtosis

NystagmusNystagmus

Page 15: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

AHP: StrabismusAHP: Strabismus

Avoid double visionAvoid double vision

Enhance depth perceptionEnhance depth perception

Page 16: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

StrabismusStrabismus

ComitantComitantAngle Angle samesame in every gazein every gaze

AHP: no benefitAHP: no benefit

IncomitantIncomitantAngle Angle variesvaries with gazewith gaze

AHP: may benefitAHP: may benefit

Page 17: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Incomitant strabismusIncomitant strabismus

A/V PatternsA/V PatternsDuane SyndromeDuane Syndrome

Cranial Nerve PalsiesCranial Nerve PalsiesMiscellaneousMiscellaneous

Page 18: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

AA--pattern: Chin Uppattern: Chin Up

Page 19: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

AA--patternpattern

Page 20: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

VV--pattern: Chin Downpattern: Chin Down

Page 21: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

VV--patternpattern

Page 22: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Duane syndromeDuane syndrome

Synkinesis 3Synkinesis 3rdrd/6/6thth nervenerveCoCo--contraction contraction (medial/lateral recti)(medial/lateral recti)

CongenitalCongenitalHearing deficitsHearing deficits

Page 23: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Duane syndromeDuane syndrome

Page 24: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Duane syndromeDuane syndrome

AADD--duction (looking in) duction (looking in) –– lids closelids close

Page 25: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Duane syndromeDuane syndrome

AABB--duction (looking out) duction (looking out) –– lids openlids open

Page 26: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Duane syndromeDuane syndrome

Lid height changes with gazeLid height changes with gaze

Page 27: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Duane syndromeDuane syndrome

Page 28: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Duane syndromeDuane syndrome

Page 29: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Duane syndromeDuane syndrome

Page 30: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Duane syndromeDuane syndrome

Page 31: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Duane SyndromeDuane SyndromeBefore surgeryBefore surgery After surgeryAfter surgery

Page 32: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Duane Syndrome?Duane Syndrome?

8 mo healthy 8 mo healthy ♂♂

Acute onset AHPAcute onset AHP

URI 1 week priorURI 1 week prior

Page 33: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Acute onsetAcute onset

Poor APoor ABB--duction duction

Lid height constantLid height constant

Duane SyndromeDuane Syndrome

Page 34: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

4 months later4 months later 11 months later11 months later

PostPost--viral 6th Nerve Palsy: Observeviral 6th Nerve Palsy: Observe

Page 35: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

66thth Nerve Palsy: When to ScanNerve Palsy: When to Scan

Not postNot post--viralviral

Not isolatedNot isolatedany other cranial nerveany other cranial nerve

any descending tract paresis/palsyany descending tract paresis/palsy

Motor or other developmental delayMotor or other developmental delay

Page 36: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

44thth Nerve Nerve ““PalsyPalsy””Most common CN AHPMost common CN AHP

Abnormal rotation: Abnormal rotation: Lax SO tendonLax SO tendon

Not actually a palsyNot actually a palsy

Page 37: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Congenital SOP = Tendon LaxityCongenital SOP = Tendon Laxity

Page 38: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern
Page 39: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern
Page 40: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern
Page 41: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

2/3 of adults with 2/3 of adults with SOP are congenital SOP are congenital casescases

Neck and face Neck and face changeschanges

Page 42: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

MidMid--facial facial hemihemi--hypoplasiahypoplasia

Page 43: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Ocular AHPOcular AHP

Strabismus Strabismus

PtosisPtosis

NystagmusNystagmus

Page 44: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

PtosisPtosis

Page 45: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

PtosisPtosis

Page 46: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

PtosisPtosis

Page 47: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern
Page 48: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern
Page 49: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern
Page 50: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern
Page 51: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Ocular AHPOcular AHP

Strabismus Strabismus

PtosisPtosis

NystagmusNystagmus

Page 52: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

NystagmusNystagmus

Involuntary rhythmic oscillationInvoluntary rhythmic oscillation

Conjugate : same direction Conjugate : same direction

Dysconjugate: different directionsDysconjugate: different directions

Page 53: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

NystagmusNystagmus

AmplitudeAmplitudeFrequencyFrequencyMagnitude = Amplitude x FrequencyMagnitude = Amplitude x Frequency

Null zone: where magnitude is Null zone: where magnitude is leastleast

Page 54: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Horizontal, conjugate nystagmus.Horizontal, conjugate nystagmus.

Page 55: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Horizontal, dysconjugate nystagmus.Horizontal, dysconjugate nystagmus.

Page 56: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Dysconjugate nystagmus.Dysconjugate nystagmus.

Page 57: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Vertical, conjugate Vertical, conjugate

Page 58: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Vertical, Dysconjugate Vertical, Dysconjugate (see(see--saw)saw)

Page 59: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

NystagmusNystagmusCan be benignCan be benign

Can herald CNS massCan herald CNS mass

““SafeSafe”” -- horizontal in all directions of gazehorizontal in all directions of gazepresent present ““since birthsince birth””decreasesdecreases with near viewingwith near viewing** albinism** albinism

Page 60: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Horizontal, conjugate nystagmus.Horizontal, conjugate nystagmus.

Page 61: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern
Page 62: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Congenital Motor NystagmusCongenital Motor Nystagmus

BenignBenign

““SafeSafe”” ---- horizontal in all directions of gazehorizontal in all directions of gazepresent present ““since birthsince birth””decreasesdecreases with near viewingwith near viewing

Null zone evident (AHP present)Null zone evident (AHP present)

Page 63: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern
Page 64: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Congenital Motor NystagmusCongenital Motor Nystagmus

BenignBenign

““SafeSafe”” ---- horizontal in all directions of gazehorizontal in all directions of gazepresent present ““since birthsince birth””decreasesdecreases with near viewingwith near viewing

Null zone evident (AHP present)Null zone evident (AHP present)

Page 65: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Null zoneNull zone

Nystagmus dampened by gazeNystagmus dampened by gaze

AHP utilized to look into null zoneAHP utilized to look into null zone

Can change early in lifeCan change early in life

Can be shifted (surgery)Can be shifted (surgery)

Page 66: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

NystagmusNystagmus

AHPAHP PostPost--opop

Page 67: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

NystagmusNystagmus

AHPAHP PostPost--opop

Page 68: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

NystagmusNystagmus

AHPAHP PostPost--opop

Page 69: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

NystagmusNystagmus

AHPAHP PostPost--opop

Page 70: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

NystagmusNystagmus

AHPAHP PostPost--opop

Page 71: Eric A. Lichtenstein, MD FAAP · Incomitant strabismus A/V Patterns Duane Syndrome Cranial Nerve Palsies Miscellaneous. A-pattern: Chin Up. A-pattern. V-pattern: Chin Down. V-pattern

Ocular AHPOcular AHP

Straighten the headStraighten the headStrabismus?Strabismus?

Ptosis?Ptosis?Nystagmus?Nystagmus?


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