title: Profile of Gaze Dysfunction following Cerebrovascular Accident.
abstract: Aim. To evaluate the profile of ocular gaze abnormalities occurring following stroke. Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol including assessment of visual acuity, ocular alignment and motility, visual field, and visual perception. Results. 915 patients recruited: mean age 69.18 years (SD 14.19). 498 patients (54%) were diagnosed with ocular motility abnormalities. 207 patients had gaze abnormalities including impaired gaze holding (46), complete gaze palsy (23), horizontal gaze palsy (16), vertical gaze palsy (17), Parinaud's syndrome (8), INO (20), one and half syndrome (3), saccadic palsy (28), and smooth pursuit palsy (46). These were isolated impairments in 50% of cases and in association with other ocular abnormalities in 50% including impaired convergence, nystagmus, and lid or pupil abnormalities. Areas of brain stroke were frequently the cerebellum, brainstem, and diencephalic areas. Strokes causing gaze dysfunction also involved cortical areas including occipital, parietal, and temporal lobes. Symptoms of diplopia and blurred vision were present in 35%. 37 patients were discharged, 29 referred, and 141 offered review appointments. 107 reviewed patients showed full recovery (4%), partial improvement (66%), and static gaze dysfunction (30%). Conclusions. Gaze dysfunction is common following stroke. Approximately one-third of patients complain of visual symptoms, two thirds show some improvement in ocular motility.
authors.affiliation: Department of Health Services Research, Thompson Yates Building, University of Liverpool, Brownlow Hill, Liverpool L69 3GB, UK.
authors.forename: Fiona J
authors.initials: FJ
authors.lastname: Rowe
authors.affiliation: Altnagelvin Hospitals HHS Trust, Altnagelvin BT47 6SB, UK.
authors.forename: David
authors.initials: D
authors.lastname: Wright
authors.affiliation: NHS Ayrshire and Arran, Ayr KA6 6DX, UK.
authors.forename: Darren
authors.initials: D
authors.lastname: Brand
authors.affiliation: Royal United Hospitals Bath NHS Trust, Bath BA1 3NG, UK.
authors.forename: Carole
authors.initials: C
authors.lastname: Jackson
authors.affiliation: Bury Primary Care Trust, Bury BL9 7TD, UK.
authors.forename: Shirley
authors.initials: S
authors.lastname: Harrison
authors.affiliation: Durham and Darlington Hospitals NHS Foundation Trust, Durham DH1 5TW, UK.
authors.forename: Tallat
authors.initials: T
authors.lastname: Maan
authors.affiliation: Ipswich Hospital NHS Trust, Ipswich IP4 5PD, UK.
authors.forename: Claire
authors.identifier: 0000-0002-0901-8413
authors.initials: C
authors.lastname: Scott
authors.affiliation: Gloucestershire Hospitals NHS Foundation Trust, Gloucester GL1 3NN, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Vogwell
authors.affiliation: St Helier General Hospital, Jersey JE2 3QS, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Peel
authors.affiliation: University Hospital NHS Trust, Nottingham NG7 2UH, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Akerman
authors.affiliation: Oxford Radcliffe Hospitals NHS Trust, Oxford OX3 9DU, UK.
authors.forename: Caroline
authors.identifier: 0000-0002-9426-1150
authors.initials: C
authors.lastname: Dodridge
authors.affiliation: Salford Primary Care Trust, Salford M6 8HD, UK.
authors.forename: Claire
authors.identifier: 0000-0002-2806-9144
authors.initials: C
authors.lastname: Howard
authors.affiliation: Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2TB, UK.
authors.forename: Tracey
authors.initials: T
authors.lastname: Shipman
authors.affiliation: Swindon and Marlborough NHS Trust, Swindon SN3 6BB, UK.
authors.forename: Una
authors.initials: U
authors.lastname: Sperring
authors.affiliation: Wrightington, Wigan and Leigh NHS Trust, Wigan WN1 2NN, UK.
authors.forename: Sonia
authors.initials: S
authors.lastname: Macdiarmid
authors.affiliation: Worcestershire Acute Hospitals NHS Trust, Worcester WR5 1DD, UK.
authors.forename: Cicely
authors.initials: C
authors.lastname: Freeman