Vertical Diplopia Secondary to Skew Deviation With Ocular Tilt Reaction With Multiple Posterior Fossa Metastases

This is a case of multiple brain metastases in the posterior fossa resulting in a skew deviation. Figure 1 : Photograph of the patient demonstrating a spontaneous right head tilt. The patient's head is tilted toward his right shoulder to suppress his diplopia Figure 2 : Ocular movements : There is a left hypertropia in primary position; the hypertropia was worse in right gaze Figure 3 : Lateral gazes : The left hypertropia and the diplopia were worse when the patient looked to the right Figure 4 : Lateral head tilt : The left hypertropia and the diplopia were worse with left head tilt Figure 5: Fundus photographs : Conjugate torsion of both eyes with the upper pole deviated toward the hypotropic eye Figure 6: T1-weighted axial brain MRI : Multiple lesions in the posterior fossa consistent with brain metastasis