Lateral Deviation of the Eyes on Forced Lid Closure in Patients With Cerebral Lesions

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.…”

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.…”

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

“…In conclusion, the SCG test may be rapidly and easily performed to detect acute unilateral intracranial lesions [2][3][4] , and it may be a good tool for the emergency room, where one needs to make a fast examinations. however, we can speculate that SCG may disappear over time, since all our patients had duration of symptoms longer than one month.…”

“…More than 30 years later, Sullivan et al 3 studied 35 patients, most with acute unilateral cerebral hemisphere lesions (9 frontal, 12 temporal, 16 parietal and 10 occipital), and registered SCG in 25 (71%) of them.…”

“…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.…”

Saccade and Smooth-Pursuit Impairment after Cerebral Hemispheric Lesions

“…Patients with unilateral cerebral lesions may not have ocular deviation when their eyes are open, but only on forced lid closure. Such devia tion is much more often contralateral than ipsilateral to the lesion [80], The mechanisms of these different forms of ocular deviation observed after unilateral cerebral damage are not yet well understood. However, relatively prolonged eye deviation, lasting at least several weeks, suggests preexisting damage to the contralateral frontal region [81], Enduring deficits caused by large chronic unilateral hemispheral lesions include [10,[82][83][84]: usual eye devia tion away from the side of the lesion on forced lid closure or in darkness; saccades with decreased velocity and increased latency, bilaterally; reduced smooth-pursuit gain ipsilateral to the lesion with, on occasion, increased gain away from the side of the lesion; reduced gain of OKN slow phase directed ipsilaterally to the lesion; VOR gain slightly asymmetric and greater for eye movements away from the side of the lesion.…”

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.…”

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

“…In conclusion, the SCG test may be rapidly and easily performed to detect acute unilateral intracranial lesions [2][3][4] , and it may be a good tool for the emergency room, where one needs to make a fast examinations. however, we can speculate that SCG may disappear over time, since all our patients had duration of symptoms longer than one month.…”

“…More than 30 years later, Sullivan et al 3 studied 35 patients, most with acute unilateral cerebral hemisphere lesions (9 frontal, 12 temporal, 16 parietal and 10 occipital), and registered SCG in 25 (71%) of them.…”

“…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.…”

Saccade and Smooth-Pursuit Impairment after Cerebral Hemispheric Lesions

“…Patients with unilateral cerebral lesions may not have ocular deviation when their eyes are open, but only on forced lid closure. Such devia tion is much more often contralateral than ipsilateral to the lesion [80], The mechanisms of these different forms of ocular deviation observed after unilateral cerebral damage are not yet well understood. However, relatively prolonged eye deviation, lasting at least several weeks, suggests preexisting damage to the contralateral frontal region [81], Enduring deficits caused by large chronic unilateral hemispheral lesions include [10,[82][83][84]: usual eye devia tion away from the side of the lesion on forced lid closure or in darkness; saccades with decreased velocity and increased latency, bilaterally; reduced smooth-pursuit gain ipsilateral to the lesion with, on occasion, increased gain away from the side of the lesion; reduced gain of OKN slow phase directed ipsilaterally to the lesion; VOR gain slightly asymmetric and greater for eye movements away from the side of the lesion.…”

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.…”

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

“…In conclusion, the SCG test may be rapidly and easily performed to detect acute unilateral intracranial lesions [2][3][4] , and it may be a good tool for the emergency room, where one needs to make a fast examinations. however, we can speculate that SCG may disappear over time, since all our patients had duration of symptoms longer than one month.…”

“…More than 30 years later, Sullivan et al 3 studied 35 patients, most with acute unilateral cerebral hemisphere lesions (9 frontal, 12 temporal, 16 parietal and 10 occipital), and registered SCG in 25 (71%) of them.…”

“…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.…”

Saccade and Smooth-Pursuit Impairment after Cerebral Hemispheric Lesions

“…Patients with unilateral cerebral lesions may not have ocular deviation when their eyes are open, but only on forced lid closure. Such devia tion is much more often contralateral than ipsilateral to the lesion [80], The mechanisms of these different forms of ocular deviation observed after unilateral cerebral damage are not yet well understood. However, relatively prolonged eye deviation, lasting at least several weeks, suggests preexisting damage to the contralateral frontal region [81], Enduring deficits caused by large chronic unilateral hemispheral lesions include [10,[82][83][84]: usual eye devia tion away from the side of the lesion on forced lid closure or in darkness; saccades with decreased velocity and increased latency, bilaterally; reduced smooth-pursuit gain ipsilateral to the lesion with, on occasion, increased gain away from the side of the lesion; reduced gain of OKN slow phase directed ipsilaterally to the lesion; VOR gain slightly asymmetric and greater for eye movements away from the side of the lesion.…”