Conjugate Eye Deviation on CT Associated With Worse Outcomes Despite IV Thrombolysis

Shah, Nirav; Bhatt, Nirav; Tipirneni, Anita; Condes, Diego; Khandelwal, Priyank; Romano, José G.

doi:10.1177/1941874416674603

Cited by 8 publications

(8 citation statements)

References 17 publications

(23 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[ 17 – 20 ] Moreover, the present study identified a strong correlation between CGAL measurements and the NIHSS scale scores, which builds on another well established association between CED and stroke symptomology. [ 2 – 9 ] The fact that the 3D CT assessment of CED is in line with prior 2D CT research and empirically validated stroke scales is a good indication that the 3D method has a similar level of validity to the classically used 2D method as a radiographic sign of AIS.…”

Section: Discussionsupporting

confidence: 57%

“…Moreover, studies evaluating the clinical significance of CED in AIS patients have repeatedly demonstrated an association between the degree of deviation to stroke severity [ 2 – 9 ] and poor prognostic outcomes. [ 2 – 4 , 10 – 14 ] This is understandable, as CED-causing lesions reflect damage to cortical areas involved in the control of spatial attention, eye movements and the frontal eye fields, [ 15 , 16 ] and thus presents as eye deviation ipsilateral to the affected brain hemisphere.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bringing prevost's sign into the third dimension: Artificial intelligence estimation of conjugate gaze adjusted length (CGAL) and correlation with acute ischemic stroke

et al. 2020

View full text Add to dashboard Cite

Conjugate gaze deviation is associated with acute ischemic stroke (AIS), although previously only measured on a 2D plane. The current study evaluates 3D imaging efficacy to assess conjugate gaze deviation and correlate direction and strength of deviation to neuro-clinical findings. A retrospective analysis of 519 patients who had CT scans for suspected AIS at our institution. Direction and angle of eye deviation were calculated based on 2D axial images. Volumetric reconstruction of CT scans allowed for calculation of 3D conjugate gaze adjusted length (CGAL). Angle, direction, and vector strength of both 2D and 3D scans were calculated by an artificial intelligence algorithm and tested for agreement with hemispheric ischemia location. CGAL measurements were correlated to NIHSS scores. Follow up MRI data was used to evaluate the sensitivity and specificity of CGAL in the identification of AIS. The final analysis included 122 patients. A strong agreement was found between 3D gaze direction and hemispheric ischemia location. CGAL measurements were highly correlated with NIHSS score ( r = .72, P = .01). A CGAL >0.25, >0.28, and >0.35 exhibited a sensitivity of 91%, 86%, and 82% and specificity of 66%, 89%, and 89%, respectively, in AIS identification. A CGAL >0.28 has the best sensitivity-specificity balance in the identification of AIS. A CGAL >0.25 has the highest sensitivity. Given CED's correlation with NIHSS score a 1/4 deviation in the ipsilateral direction is a sensitive ancillary radiographic sign to assist radiologists in making a correct diagnosis even when not presented with full clinical data.

show abstract

Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Bringing prevost's sign into the third dimension: Artificial intelligence estimation of conjugate gaze adjusted length (CGAL) and correlation with acute ischemic stroke

et al. 2020

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Horizontal conjugate eye deviation (CED) provides valuable localizing information and occurs in about 20% of acute stroke presentations. 2,3 The causes of CED are summarized in the Table . In our case, the patient's eyes were at times tonically deviated to the left, which became apparent when fixation was removed, with eyes closed and in the scanner. Traditional teaching is that the gaze deviation is generally directed towards the side of the lesion in the well-recognized case of supratentorial strokes which disrupt the cortical frontal eye fields and associated pathways.…”

Section: Localization Of Conjugate Eye Deviationmentioning

confidence: 99%

Ocular Ipsipulsion Caused by Posterior Inferior Cerebellar Artery Stroke

Britton

Scott

2022

Stroke

View full text Add to dashboard Cite

show abstract

“…2,11 Some articles reported that RHGD had similar characteristics as PHGD; it was more frequently encountered with right hemispheric lesions than with left ones, 12 and was associated with large affected volumes 12,13 and hemispatial neglect. 14 Moreover, the frequency of RHGD was influenced by stroke causative mechanisms and affected arterial territories; that is, it was frequent in cardioaortic embolism (CAE) 13 and in ischemic lesions of the middle cerebral artery (MCA) and posterior inferior cerebellar artery (PICA) territories. 15 As for the relationship between PHGD and RHGD, in the literature, patients with RHGD had PHGD more frequently than those without.…”

Section: Introductionmentioning

confidence: 99%

Clinical Differences between Radiographic and Physical Horizontal Gaze Deviation: Utility of Using the Two in Patients with Ischemic Stroke

Kobayashi

2024

The Neurohospitalist

View full text Add to dashboard Cite

Background and Purpose Radiographic horizontal gaze deviation (RHGD) has been identified as a useful finding on computed tomography (CT) that indicates the affected side in supratentorial ischemic stroke; however, it remains unclear whether RHGD is essentially the same phenomenon as physical horizontal gaze deviation (PHGD). To resolve the issue, this study was conducted. Methods Retrospective analyses were performed for 671 patients with ischemic stroke and 142 controls who were hospitalized and underwent head CT. First, clinical findings were examined to find differences between RHGD-positive and RHGD-negative patients. Second, patients were classified by their stroke mechanisms and/or affected vascular territories. For each subgroup, RHGD was compared with PHGD in frequency. Third, the proportions for patients divided by positivity for PHGD and RHGD were calculated in the subgroups. Results Patients with RHGD had PHGD more often than those without. In all stroke subgroups, RHGD was more frequent than PHGD. The frequency difference was prominent in small-artery occlusion (SAO) and posterior inferior cerebellar artery (PICA) stroke. In SAO of the basilar artery pontine perforator, RHGD was positive in 25% and largely contralesionally-directed. In PICA stroke, lesions in the vestibulocerebellum were associated with contralesional RHGD. Moreover, lesions in the lateral medulla also caused RHGD, which was mainly directed to the ipsilesional side. PHGD-positive stroke without RHGD was infrequent, whereas RHGD-positive stroke without PHGD was commonly observed (PICA stroke, 45.9%; other subgroups, 21.1%-27.5%). Conclusions RHGD had different characteristics from PHGD; therefore, assessments of both PHGD and RHGD may lead to more accurate diagnoses.

show abstract

Conjugate Eye Deviation on CT Associated With Worse Outcomes Despite IV Thrombolysis

Abstract: The CT-CED is associated with higher initial NIHSS, large vessel occlusion, and AF. Prospective studies are needed to ascertain whether CT-CED may be utilized part of a screen for endovascular therapy.

Cited by 8 publications

References 17 publications

Bringing prevost's sign into the third dimension: Artificial intelligence estimation of conjugate gaze adjusted length (CGAL) and correlation with acute ischemic stroke

Bringing prevost's sign into the third dimension: Artificial intelligence estimation of conjugate gaze adjusted length (CGAL) and correlation with acute ischemic stroke

Ocular Ipsipulsion Caused by Posterior Inferior Cerebellar Artery Stroke

Clinical Differences between Radiographic and Physical Horizontal Gaze Deviation: Utility of Using the Two in Patients with Ischemic Stroke

Contact Info

Product

Resources

About