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Driving Simulation in the Clinic: Testing Visual Exploratory Behavior in Daily Life Activities in Patients with Visual Field Defects

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Wrong-way deviation: contralateral conjugate eye deviation in acute supratentorial stroke.

Ken Johkura¹, Yoshiharu Nakae, Ryoo Yamamoto

¹Department of Neurology and Stroke Center, Hiratsuka Kyosai Hospital, Hiratsuka, Japan. johkura-k@kkr.hiratsuka.kanagawa.jp

Journal of the Neurological Sciences

|June 28, 2011

Summary

Wrong-way deviation, a rare eye movement disorder after supratentorial stroke, can result from both hemorrhagic and extensive ischemic strokes. Early surgical decompression may improve outcomes for affected patients.

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Area of Science:

Neurology
Neuroscience
Ophthalmology

Background:

Supratentorial stroke can cause conjugate eye deviation to the side opposite the lesion (wrong-way deviation).
This phenomenon is rare and has been primarily associated with hemorrhagic stroke.

Purpose of the Study:

To prospectively investigate the clinical features of wrong-way deviation.
To determine the prognostic significance of wrong-way deviation in supratentorial stroke patients.

Main Methods:

Prospective evaluation of 12 patients with wrong-way deviation following supratentorial stroke.
Analysis of clinical features and outcomes in patients from a cohort of 968 consecutive supratentorial stroke admissions.

Main Results:

The incidence of wrong-way deviation was 1.2%.
Causative lesions included large intracranial hemorrhage (7/12) or extensive hemispheric infarction (5/12).
Patients undergoing surgical decompression showed improved consciousness compared to those treated conservatively.

Conclusions:

Wrong-way deviation can occur in both hemorrhagic and extensive ischemic supratentorial strokes.
Damage to the rostral brainstem's crossing oculomotor pathways likely explains the deviation and associated signs.
Prompt surgical decompression may be crucial for improving prognosis in these cases.