J Clin Neurol.  2019 Apr;15(2):228-234. 10.3988/jcn.2019.15.2.228.

Conjugate Eye Deviation in Unilateral Lateral Medullary Infarction

Affiliations
  • 1Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany. katharina.feil@med.uni-muenchen.de
  • 2German Center for Vertigo and Balance Disorders, Ludwig Maximilian University (LMU), Munich, Germany.
  • 3Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany.
  • 4Department of Neurology Inselspital, Bern University Hospital, Bern, Switzerland.

Abstract

BACKGROUND AND PURPOSE
The initial diagnosis of medullary infarction can be challenging since CT and even MRI results in the very acute phase are often negative.
METHODS
A retrospective, observer-blinded study of horizontal conjugate eye deviation was performed in 1) 50 consecutive patients [age 58±15 years (mean±SD), 74% male, National Institutes of Health Stroke Scale 2±1] with acute unilateral lateral medullary infarction as seen in MRI (infarction group), 2) 54 patients with transient brainstem symptoms [transient ischemic attack of brainstem (TIA) group; age 69±16 years, 59% male], and 3) 53 patients (age 59±20 years, 49% male) with diagnoses other than stroke (control group).
RESULTS
Conjugate eye deviation was found in all patients in the infarction group [n=47 (94%) with ipsilesional deviation and n=3 (6%) with contralesional deviation] compared to 41% (n=22) in the brainstem TIA group and 15% (n=8) in the control group (p<0.0001). Within all groups mean deviation and range were similar for both sides (to the right vs. to the left side 26.6°±12.3 vs. 26.1°±12.3 in the infarction group, 10.5°±5.8 vs. 8.4°±6.3 in the brainstem TIA group and 4.5°±3.2 vs. 7.5°±3.2 in the control group). The extent of eye deviation was significantly greater in the infarction group (p<0.05).
CONCLUSIONS
All patients with MRI-demonstrated unilateral medullary infarction showed conjugate eye deviation. Therefore, conjugate eye deviation in patients with suspected acute lateral medullary infarction is a helpful sensitive sign for supporting the diagnosis, particularly if the deviation is >20°.

Keyword

dorsolateral medullary syndrome; eye motility disorders; cerebral stroke; transient ischemic attack; neurological examination; orthoptics

MeSH Terms

Brain Stem
Diagnosis
Humans
Infarction*
Ischemic Attack, Transient
Lateral Medullary Syndrome
Magnetic Resonance Imaging
Male
National Institutes of Health (U.S.)
Neurologic Examination
Ocular Motility Disorders
Orthoptics
Retrospective Studies
Stroke
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