Neuroimaging of eye position reveals spatial neglect

Abstract

Conjugate eye deviation describes the tonic horizontal deviation of the eyes in acute stroke patients. Here we investigate whether measuring patients' eye-in-head position in clinical magnetic resonance imaging or computed tomography scans obtained at admission shows a specific relationship to spatial neglect. We investigated 124 continuously admitted subjects with unilateral, first-ever left- or right-sided stroke. To control for the possibility that the degree of eye deviation is related to lesion size rather than spatial neglect, overall lesion volume was used as a covariate in the statistical analysis. Horizontal eye-in-head deviation on clinical brain scans appeared to be associated with spatial neglect rather than with brain damage per se. In contrast to the subject groups without the disorder, the patients with spatial neglect showed an eye-in-head position that was significantly deviated towards the ipsilesional right. Evaluation of eye-in-head position on clinical scans thus may be an additional helpful tool for diagnosing spatial neglect, particularly in the very early period of the stroke.

The “DeyeCOM Sign”: Predictive Value in Acute Stroke Code Evaluations

“…Although beyond the scope of our analysis, the usual eyes closed position in the CT scanner, removing fixation, may result in a higher likelihood of tonic eye deviation from a non-dominant hemisphere lesion as noted by other authors(11). …”

Wrong-way deviation: Contralateral conjugate eye deviation in acute supratentorial stroke

“…Ipsilateral conjugate eye deviation occurs most frequently in patients with right hemispheric stroke because of the right hemispheric predominance of the central spatial attention system; the right hemisphere plays an important role in spatial attention, and right hemispheric stroke (in contrast to left hemispheric stroke) frequently causes contralateral (left) spatial neglect or gaze palsy [8,9]. Interestingly, the wrong-way deviation observed in our patients was most frequently associated with left-sided stroke.…”

A Preliminary Study of the Assessment of Visual Space Recognition in Stroke Patients using New Head Mounted Display (HMD) System with Visual Image Transformation

“…VFD patient 2 may have exhibited a tendency to orient the trunk to the direction of deficit due to a limited residual visual field. Acute-phase USN patients have been reported to frequently deviate gaze to the right, with head deviation being observed in severe cases [33,34]. USN patient 2, who presented with severe neglect, indicated a tendency for right head rotation, suggesting that the environmental circumstances of presenting visual information via the HMD influenced head movement.…”