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

Um Desvio Inesperado

“…[1][2][3] Caracteriza-se pelo desvio do olhar no sentido contrário ao do hemisfério afetado e na sua génese estão geralmente hemorragias talâmicas ou enfartes cerebrais extensos com compressão do tronco cerebral. 2 Uma das teorias explicativas afirma que uma lesão supratentorial com efeito de massa significativo pode lesionar as vias oculomotoras sacádicas descendentes que decussam no mesencéfalo rostral e terminam na ponte contralateral. 2,3 A lesão das fibras que já decussaram pode assim resultar num desvio contralateral do olhar.…”

“…[3][4][5] O facto de este fenómeno ocorrer vários dias após o acidente vascular cerebral -quando o edema é mais significativo -concorda com estas hipóteses. 2 Uma vez que o wrong-way deviation pode ser confundível com outras causas de desvio contralateral do olhar em doentes com baixo nível de consciência, o seu reconhecimento é importante.…”

Neuro-ophthalmology Annual Review

“…The wrong-way deviation usually appears a few days after the initial insult and is frequently accompanied by transient downward eye deviation, which is perhaps due to damage in the rostral brainstem. 87 In the wall-eyed bilateral internuclear ophthalmoplegia syndrome, there is a bilateral adduction deficit with exotropia, impaired convergence, and a bilateral horizontal dissociated abducting eye nystagmus elicited on horizontal gaze. Although a lesion of the rostral midbrain is a common cause of the walleyed bilateral internuclear ophthalmoplegia syndrome, a recent case report discussed an affected patient with a medial dorsal pontine lesion on diffusion-weighted imaging MRI.…”

Electroencephalography Findings in Wrong Way Eyes: Unilateral Hemispheric Dysfunction Supporting Smooth Pursuit Asymmetry Hypothesis

“…Miller Fisher was the first to report a case series of WWE in 3 patients with large thalamic hemorrhages (1). Thereafter, the phenomenon was historically considered to occur in the context of thalamic hemorrhages, although the largest published case series, which identified 12 patients with WWE among 968 consecutive stroke patients, found that 5 of the cases had large ischemic infarcts (2).…”

“…There is neuropathologic support for this hypothesis because the dissection of blood into the midbrain was seen on autopsy of some reported cases of WWE (1,8). The association of vertical eye deviation in some, and reduced level of consciousness in most, patients with WWE is also thought to be suggestive of bilateral deep gray matter or midbrain involvement (2).…”