Conjugate eye deviation after acute hemispheric stroke: delayed recovery after previous contralateral frontal lobe damage

In 42 patients with acute unilateral ischemic or hemorrhagic hemispheric stroke, conjugate eye deviation toward the lesioned side was usually of brief duration. It subsided within 48 hours in 24 patients (57%) and lasted no longer than 5 days in 38 patients (90%). Early disappearance of conjugate eye deviation was an isolated phenomenon and preceded any improvement in the other focal neurological deficits, which persisted in their initial severity. In 6 additional patients with stroke, conjugate eye deviation was remarkably prolonged, lasting from 13 to more than 43 days. In all 6 there was evidence for preexisting damage to the contralateral frontal region. Our study suggests that early recovery of conjugate eye deviation in patients with acute hemispheric stroke may be mediated by the contralateral unaffected frontal eye field.