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Published on: October 15, 2021
Conjugate eye deviation in acute intracerebral hemorrhage: stroke acute management with urgent risk-factor assessment
Shoichiro Sato1, Masatoshi Koga, Hiroshi Yamagami
1Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan. sato.shoichiro.hp@mail.ncvc.go.jp
Insights
Persistent conjugate eye deviation (CED) in acute stroke patients predicts poor outcomes. Factors like lesion location and hematoma volume influence CED, which is a significant predictor of death or dependency after intracerebral hemorrhage.
Area of Science:
- Neurology
- Neurosurgery
- Stroke Medicine
Background:
- Conjugate eye deviation (CED) is a common finding in acute stroke patients.
- Understanding factors associated with CED and its prognostic value in acute intracerebral hemorrhage (ICH) is crucial.
Purpose of the Study:
- To identify factors correlating with CED in acute supratentorial ICH.
- To determine the relationship between CED and patient outcomes at 3 months post-stroke.
Main Methods:
- A prospective, multicenter study included 211 patients with acute supratentorial ICH.
- CED was assessed using the National Institutes of Health Stroke Scale (NIHSS) best gaze subscore.
- Hematoma location, volume, and intraventricular extension were evaluated via CT scans.
Main Results:
- 45% of patients exhibited CED.
- Independent predictors of CED included right-sided lesions, larger hematoma volume, and lower baseline Glasgow Coma Scale (GCS) scores.
- Persistent CED (at admission and 72 hours) independently predicted death or dependency at 3 months (OR, 5.77).
- Optimal hematoma volume cutoffs for CED were ≥13.5 mL for putaminal and ≥7.7 mL for thalamic hemorrhages.
Conclusions:
- Persistent CED is a significant predictor of poor outcomes in acute supratentorial ICH, independent of initial severity and hematoma volume.
- Thalamic hemorrhages may require smaller volumes to evoke CED compared to putaminal hemorrhages.
Background And Purpose:
Conjugate eye deviation (CED) occurs frequently in patients with acute stroke. The purpose of this study was to elucidate the factors that correlate with CED as well as the relationship between CED and outcomes in patients with acute intracerebral hemorrhage.
Methods:
A total of 211 patients with acute supratentorial intracerebral hemorrhage were recruited in a multicenter, prospective study. CED was assessed with a National Institutes of Health Stroke Scale "best gaze" subscore of ≥1. Hematoma location and volume were assessed on CT.
Results:
Forty-five percent of the patients had CED. On multivariable analysis, right-sided lesion (OR, 2.36; 95% CI, 1.18-4.93), hematoma volume (OR, 1.07; 95% CI, 1.04-1.10 per 1 mL), and baseline Glasgow Coma Scale score (OR, 0.66; 95% CI, 0.53-0.80 per 1 point) were independently associated with CED. After adjusting for sex, age, intraventricular extension of the hematoma, baseline Glasgow Coma Scale score, and hematoma volume, the presence of CED both on admission and 72 hours later was an independent predictor of death or dependency at 3 months poststroke (OR, 5.77; 95% CI, 2.27-16.94). The optimal cutoff volume of hematoma related to CED was ≥13.5 mL for patients with putaminal hemorrhage (sensitivity, 76%; specificity, 72%) and ≥7.7 mL for patients with thalamic hemorrhage (sensitivity, 82%; specificity, 83%).
Conclusions:
The persistence of CED was a significant predictor of death or dependency after acute supratentorial intracerebral hemorrhage even after adjusting for initial severity and hematoma volume. CED can be evoked by a relatively smaller thalamic hematoma than a putaminal hematoma.
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