title: Ocular lateropulsion as a central oculomotor sign in acute vestibular syndrome is not posturally dependent.
abstract: Horizontal conjugate gaze deviation (h-CGD) in acute vestibular syndrome (AVS) may be detected clinically or radiographically. While upright clinical ocular lateropulsion (OL) predicts central lesions, supine radiographic h-CGD does not. We sought to investigate the cause for this discordance by comparing upright to supine OL in AVS. We prospectively recorded clinical and radiographic h-CGD in 17 AVS patients. Horizontal eye position after brief eyelid closure was tested clinically following postural shifts. Radiographic h-CGD was assessed on axial magnetic resonance imaging (MRI) or computerized tomography (CT) images. All maintained central fixation with eyes open in light. OL was present in 8 (7 strokes, one central demyelination) and radiographic h-CGD in 14 (including all 6 with peripheral lesions). OL was unchanged after static postural testing. OL predicts central pathology and does not vary with postural shifts, regardless of lesion location. Radiographic h-CGD does not help localize, and this is not a positional effect.
authors.affiliation: Department of Neurology, The University of Illinois College of Medicine at Peoria and Illinois Neurological Institute at OSF Saint Francis Medical Center, Peoria, Illinois 61637, USA. kattahj@uic.edu
authors.forename: Jorge C
authors.initials: JC
authors.lastname: Kattah
authors.forename: John
authors.initials: J
authors.lastname: Pula
authors.forename: David E
authors.initials: DE
authors.lastname: Newman-Toker
mesh_terms: D003711:Demyelinating Diseases / Q000503:physiopathology; D003941:Diagnostic Techniques, Ophthalmological; D006801:Humans; D008279:Magnetic Resonance Imaging; D015835:Ocular Motility Disorders / Q000175:diagnosis / Q000503:physiopathology*; D011187:Posture / Q000502:physiology; D011446:Prospective Studies; D020521:Stroke / Q000503:physiopathology; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D015837:Vestibular Diseases / Q000175:diagnosis / Q000503:physiopathology*; D020338:Vestibular Neuronitis / Q000175:diagnosis / Q000503:physiopathology*