Ocular lateral deviation with brief removal of visual fixation differentiates central from peripheral vestibular syndrome.

Autor: Kattah JC; Department of Neurology. Illinois Neurologic Institute, University of Illinois College of Medicine, Peoria, IL, USA. kattahj@uic.edu., Badihian S; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Pula JH; Northshore University Health System, Evanston, Il, USA., Tarnutzer AA; Neurology, Cantonal Hospital of Baden, Baden, Switzerland.; Faculty of Medicine, University of Zurich, Zurich, Switzerland., Newman-Toker DE; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Zee DS; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Ophthalmology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Jazyk: angličtina
Zdroj: Journal of neurology [J Neurol] 2020 Dec; Vol. 267 (12), pp. 3763-3772. Date of Electronic Publication: 2020 Jul 28.
DOI: 10.1007/s00415-020-10100-5
Abstrakt: Objective: Ocular lateral deviation (OLD) is a conjugate, ipsilesional, horizontal ocular deviation associated with brief (3-5 s) closing of the eyes, commonly linked to the lateral medullary syndrome (LMS). There is limited information regarding OLD in patients with the acute vestibular syndrome (AVS). In one case series 40 years ago OLD was suggested to be a central sign. Recently, horizontal ocular deviation on imaging (RadOLD) was frequently associated with anterior circulation stroke and horizontal gaze palsy. Similarly, RadOLD has been associated with posterior circulation stroke, e.g., LMS and cerebellar stroke, but without clinical correlation with OLD.
Methods: This is a prospective, cross-sectional diagnostic study of 151 acute AVS patients. Patients had spontaneous nystagmus. Horizontal gaze paralysis was an exclusion criterion. We noted the effect of brief 3-5 s eyelid closure on eye position, and then used the HINTS algorithm (the head-impulse test, nystagmus characteristics and skew deviation) and RadOLD, to establish a correlation between clinical and radiologic findings RESULTS: Of the 151 AVS patients, 100 had a central lesion and 51 a peripheral lesion; 29 of the central lesions were LMS, and 11 had OLD. Additionally, one lateral pontine syndrome had OLD. On opening the eyes 11 patients with OLD and LMS made multiple, hypometric corrective saccades to bring gaze back to straight ahead. 10/11 patients with LMS showed RadOLD.
Conclusions: OLD with multiple hypometric corrective saccades on opening the eyes was infrequent but highly localizing and lateralizing. We emphasize how simple it is to test for OLD, with the caveat that to be specific, it must be present after just brief (3-5 s) eyelid closure.
Databáze: MEDLINE
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