In a patient with a superior oblique (SO) palsy, which direction does the patient typically tilt their head to compensate?

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Multiple Choice

In a patient with a superior oblique (SO) palsy, which direction does the patient typically tilt their head to compensate?

Explanation:
When the superior oblique is weak, the affected eye tends to ride higher and extort, especially as it adducts, causing vertical diplopia that worsens with head tilt toward the side of the lesion. To minimize double vision, the patient naturally tilts the head away from the affected eye. Tilting toward the opposite shoulder uses the intact muscles to help align the eyes more effectively, reducing the misalignment in common viewing positions. So the typical compensatory head tilt is toward the opposite shoulder, contralateral to the lesion.

When the superior oblique is weak, the affected eye tends to ride higher and extort, especially as it adducts, causing vertical diplopia that worsens with head tilt toward the side of the lesion. To minimize double vision, the patient naturally tilts the head away from the affected eye. Tilting toward the opposite shoulder uses the intact muscles to help align the eyes more effectively, reducing the misalignment in common viewing positions. So the typical compensatory head tilt is toward the opposite shoulder, contralateral to the lesion.

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