Evaluation of the "spasticity of conjugate gaze phenomenon" in unilateral cerebral lesions

Abstract

The spasticity of conjugate gaze (SCG) is a subtle motor ocular sign of a monohemispheric cerebral lesion first noticed almost simultaneously by Prezzolini and Bárány in 1913 1 . It is described as a lateral conjugate deviation of the eyes to the side opposite of the lesion on attempted forced closure of the lids. This sign was present in patients with unilateral cerebral lesions in a series published by Cogan 1 . Later on, it was associated mainly, but not exclusively, to the presence of parietotemporal lesions 2 , and it was most recently observed in 70% of patients with radiologically proven unilateral acute cerebral lesions 3 . In all previously studied groups, the patients had other clear signs of central nervous system lesions such as hemiparesia, hemianopia or aphasia.The present study sought to determine the sensitivity of SCG as a sign of a long-lasting (over one month) monohemispheric lesion in patients with known brain tumors and no evidence of conjugate gaze paresis or other motor symptoms. MethodSeventy one outpatients seen at the Department of Neurosurgery in the National Cancer Institute of Rio de Janeiro were enrolled in the study. Among these, 57 been diagnosed with monohemispheric brain tumor. All patients' symptoms had lasted longer than one month. Fourteen individuals without cerebral lesions were included as controls.Patients and controls underwent complete neurological examination and were submitted to a brain magnetic resonance image (MRI) reviewed by the neurologists. Then they were blindly evaluated (no access to neurological data, clinical data, or image results) by one of us (ETM) with the "mini mental state examination" and specifically screened for some motor signs, including SCG.evaluation of the "SpaSticity of conjugate gaze phenoMenon" in unilateral cerebral leSionS ABSTRACT -The spasticity of conjugate gaze phenomenon (SCG) is a subtle motor ocular sign that usually indicates unilateral acute cerebral lesion. We analyzed the sensitivity of this sign in a prospective blinded study using 57 patients. All patients had monohemispheric brain lesions without resting deviation of the eyes and no motor complaints. Fourteen individuals without cerebral lesions were included as controls.Patients and controls were submitted to a brain magnetic resonance image. We observed SCG in just 1/57 (sensitivity of 1.7%), while all controls had a normal Bell's phenomenon. We speculate that SCG may disappear over time and is not useful to diagnose a long-lasting unilateral brain lesion.KEy WoRDS: spastic conjugate gaze phenomenon, brain tumor, semiology.avaliação do "fenômeno do desvio conjugado espástico ocular" em lesões cerebrais unilaterais PALAvRAS-ChAvE: fenômeno do desvio ocular conjugado espástico, tumor cerebral, semiologia.

Contralesional Spasticity of Conjugate Gaze in Striatocapsular Infarction

“…Gaze deviation with eye closure, but not with eyes open has been reported primarily in patients with lesions involving the medulla and cerebellum (ocular lateropulsion), 1,2 but our patient had no infratentorial lesions. A similar phenomenon has been also described for supratentorial lesions as the name of perverted Bell's phenomenon or spasticity of conjugate gaze (SCG), which is characterized by gaze deviation predominantly to the contralesional side with forced or attempted eye closure; [3][4][5][6] therefore, the ocular motor symptom observed in our patient is compatible with SCG. SCG has been reported primarily in parietotemporal lesions, 4,5 but, to the best of our knowledge, has never been reported in isolated striatocapsular infarction.…”

O Sinal do Quinto Dedo, o Fenômeno dos Interósseos de Souques e o Teste do Desvio Pronador como Sinais Motores Sutis em Pacientes com Tumor Cerebral Monoemisférico

“…They were then blindly evaluated (no access to neurological data, clinical data, or imaging results) by one of the examiners (M.E.T.) with the mini mental status examination (MMSE) and specifically screened for several motor signs 5 , including DQS, SIP, and PDT.…”