Journal of Neurology

, Volume 259, Issue 12, pp 2555–2564 | Cite as

Clinical and imaging features of the room tilt illusion

  • F. Sierra-HidalgoEmail author
  • E. de Pablo-Fernández
  • A. Herrero-San Martín
  • E. Correas-Callero
  • J. Herreros-Rodríguez
  • J. P. Romero-Muñoz
  • L. Martín-Gil
Original Communication


Room tilt illusion (RTI) is a transient disorder of the environmental visuo-spatial perception consisting of paroxysmal tilts of the visual scene. It is attributed to an erroneous cortical mismatch of the visual and vestibular three-dimensional coordinate maps. Thirteen subjects were included in this retrospective case series. Clinical presentation was 180º rotation of the visual scene following the coronal plane in seven patients. The most common cause for RTI in our series was posterior circulation ischaemia (five cases). Cases of endolymphatic sac tumour, critical illness neuropathy, acute traumatic myelopathy and multiple system atrophy causing RTI are reported for the first time. No case of supratentorial focal lesion was found. In order to describe the clinical and imaging features of RTI, 135 cases previously reported in the literature were reviewed along with our series. There was a male predominance (60.2 %). Mean age was 51.2 ± 20.3 years. The most common location of the injury was the central nervous system (CNS) (61.4 %). Supratentorial and infratentorial structures accounted for the same frequency of lesions. The most common aetiology was cerebral ischaemia (infarction or transient ischaemic episode; 27.7 %). These patients were significantly older and their lesions commonly involved posterior fossa structures when compared to patients with non-vascular disorders. In summary, RTI is a manifestation of several CNS and vestibular disorders, and rarely of peripheral nervous system disorders, triggered by disruption of vestibular and sensory perception or integration. Cerebral ischaemic disorders are the most common aetiology for this rare syndrome.


Room tilt illusion Stroke Visual tilt illusion Magnetic resonance imaging Computed tomography Vestibular system Subjective visual vertical 



Dr. F. Sierra-Hidalgo receives financial support from the Instituto de Salud Carlos III through a Río Hortega contract. We are grateful to Mr. Jorge Gómez Tovar for the illustration in Fig. 1.

Conflicts of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • F. Sierra-Hidalgo
    • 1
    • 2
    Email author
  • E. de Pablo-Fernández
    • 1
  • A. Herrero-San Martín
    • 1
  • E. Correas-Callero
    • 1
  • J. Herreros-Rodríguez
    • 1
  • J. P. Romero-Muñoz
    • 1
  • L. Martín-Gil
    • 1
  1. 1.Department of NeurologyHospital Universitario 12 de Octubre, and Instituto de Investigación Hospital 12 de Octubre (i+12)MadridSpain
  2. 2.Department of NeurologyHospital Universitario 12 de Octubre, and Neurology/Neurosciences Research Group, Instituto de Investigación Hospital 12 de Octubre (i+12)MadridSpain

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