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

The Sustained DeyeCOM Sign as a Predictor of Large Vessel Occlusions and Stroke Mimics

“…This line intersected with the perpendicular line to create an angle, which was measured as the angle of gaze deviation (See Figure 1). As previously reported(8), cases with conjugately deviated gaze with angles > 15 degrees in each eye on NCCT were noted to be DeyeCOM(+). The absence of conjugate gaze deviation on NCCT was noted to be DeyeCOM(−).…”

“…Angle of gaze deviation was measured using IMPAX caliper tool. As with our prior publications(8), a midline was created through the nasal septum and occiput, then a perpendicular line was created. Subsequently, a line was drawn through the longest diameter of the lens.…”

“…The DeyeCOM sign has shown good specificity for AIS(8). Due to the brevity of CT, a false positive DeyeCOM sign may be noted for many reasons including alternate etiologies (intracerebral hemorrhage (ICH), seizure)(9), chance, or volitional gaze towards a point of interest.…”

“…Gaze deviation is included in the National Institute of Health Stroke Scale (NIHSS) Score and other scales(7). Gaze deviation may be appreciated on imaging as the DeyeCOM sign(8), and may be the first evidence found of a patient having a cortical deficit.…”

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

“…2 Conjugate eye deviation (CED) can localize to multiple areas including the medial frontal gyrus, the parapontine reticular formation, and other cortical areas involved in spatial neglect, [3][4][5] and may be associated with other acute neurological events such as seizure, postictal states, and systemic mimics of stroke such as hyperglycemia. [6][7][8] Ipsilateral CED on brain CT (CT-CED) has been associated with worse outcomes in patients with stroke 9 but has not been evaluated as a tool in identifying acute endovascular therapy candidates. The CED suggests cortical frontal lobe involvement in most cases and may indicate large vessel occlusion.…”