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Contralateral gaze deviation with supratentorial hemorrhage.

J R Keane

    Archives of Neurology
    |February 1, 1975
    PubMed
    Summary
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    Deep brain hemorrhages can cause "wrong-side" gaze deviation. This finding in supratentorial intracerebral hemorrhage cases suggests thalamic bleeds can affect eye movements without impacting known pathways.

    Area of Science:

    • Neurology
    • Neuroscience
    • Ophthalmology

    Background:

    • Spontaneous supratentorial intracerebral hemorrhage (ICH) can present with neurological deficits.
    • Contralateral sustained conjugate gaze deviation is a known sign, but its localization is debated, especially with deep ICH.
    • Existing oculomotor pathway knowledge does not fully explain "wrong-side" gaze deviation in all ICH cases.

    Purpose of the Study:

    • To investigate the mechanism of contralateral sustained conjugate gaze deviation in patients with deep supratentorial intracerebral hemorrhage.
    • To explore the potential role of thalamic-basal ganglia hemorrhages in causing "wrong-side" gaze deviation.
    • To enhance the understanding of oculomotor localization in the context of deep ICH.

    Main Methods:

    • Case study of three patients with spontaneous supratentorial intracerebral hemorrhage.

    Related Experiment Videos

  • Clinical observation of contralateral sustained conjugate gaze deviation.
  • Autopsy examination to determine the location and extent of cerebral hemorrhages.

    • Main Results:

    • All three patients exhibited contralateral sustained conjugate gaze deviation.
    • Autopsies revealed large thalamic-basal ganglia hemorrhages with caudal extension limited to the midbrain.
    • The observed gaze deviation occurred without involvement of postdecussation horizontal oculomotor pathways.

    Conclusions:

    • Thalamic hemorrhage can induce contralateral gaze deviation independently of postdecussation oculomotor pathways.
    • The mechanism for "wrong-side" gaze deviation in these cases remains obscure but may involve thalamic structures.
    • Awareness of contralateral gaze deviation as a sign of deep supratentorial hemorrhages can aid in hematoma localization.