Frequency of eye deviation in stroke and non-stroke patients undergoing head CT

Although conjugate eye deviation (CED) on head CT has been described in patients with acute stroke, the incidence in other patient groups remains unknown. The aim of this study was to determine the frequency of eye deviation on head CT in non-stroke patients compared to patients with acute stroke symptoms.

Three groups of patients were identified retrospectively: emergency department (ED)/inpatients undergoing head CT for non-stroke symptoms (group 1), stroke patients receiving intravenous tPA (group 2), and stroke patients undergoing intra-arterial therapy (group 3). The presence on head CT of CED, lone eye deviation (LED), and skew deviation (SD) and the angle of deviation were recorded. The NIHSS score was recorded for groups 2 and 3.

CED was present in 17 (14%) of 120 Group 1 patients, 17 (36%) of 47 group 2 patients, and 28 (50%) of 56 Group 3 patients (p < 0.0001). Mean deviation of CED in groups 1, 2, and 3 was 19(o) (range 7-36(o)), 25(o) (range 6-67(o)), and 27(o) (range 11-56(o)), respectively (p = 0.024). LED was seen in 42 (35%) of group 1, 7 (15%) of Group 2, and 2 (4%) of group 3 patients (p < 0.0001). There was no significant difference in SD among groups (p = 0.37). CED was associated with a higher National Institutes of Health Stroke Scale (NIHSS) score among stroke patients (p = 0.0008).

CED is common in patients with acute stroke. Such deviation may be seen in non-stroke patients, but less commonly and with lesser degrees of deviation.