title: Conjugate eye deviation as predictor of acute cortical and subcortical ischemic brain lesions.
abstract: OBJECTIVE
  Non-enhanced computed tomography (NECT) of the brain is used to exclude intracranial hemorrhage in patients who are considered for treatment with tissue plasminogen activator due to stroke symptoms. However, early infarct signs on NECT have low sensitivity for ischemic stroke. It was hypothesized that horizontal conjugate eye deviation (average ocular gaze deviation-OGD >14°) on NECT predicts ischemic brain injury on a second detailed examination.
  
  
  METHODS
  Patients who underwent brain NECT within three hours after the onset of stroke symptoms and subsequently had brain CT scan with intravenous contrast or MRI were potential participants. OGD was measured from the cross-sectional image including both globes at their maximum diameter.
  
  
  RESULTS
  73 subjects were studied (mean age 64.2±20.8 years) with a median interval (interquartile range) of 56 h (22-109.3 h) between NECT and the second examination. On NECT, 24 of 73 (32.9%) subjects had OGD >14°. Of 32 individuals with acute ischemic injury on the second examination, 19 (59.4%) had OGD >14° on NECT. OGD >14° was associated with increased risk of ischemic injury: OR=10.5 (95% confidence interval 3.33-33.9); P=0.002. OGD >14° had significantly higher sensitivity and negative predictive value than early infarct signs on NECT (59.4% vs. 21.9% and 73.5% vs. 59.7%, respectively; P<0.05), and similar specificity and positive predictive value (87.8% vs. 90.2% and 79.2% vs. 63.6%; P>0.05).
  
  
  CONCLUSIONS
  In the presence of stroke symptoms, average OGD >14° on the initial brain NECT is early predictor of ischemic brain injury.
authors.affiliation: Department of Neurology, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece. Electronic address: kaditis@hotmail.com.
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Kaditis
authors.affiliation: Department of Biomathematics, University of Thessaly School of Medicine and Larissa University Hospital, Larissa,Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Zintzaras
authors.affiliation: Department of Neurology, Euroclinic Hospital, Athens, Greece.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Sali
authors.affiliation: Department of Radiology, Euroclinic Hospital, Athens, Greece.
authors.forename: Grigorios
authors.initials: G
authors.lastname: Kotoulas
authors.affiliation: Department of Neurology, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Papadimitriou
authors.affiliation: Department of Neurology, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece.
authors.forename: Georgios M
authors.initials: GM
authors.lastname: Hadjigeorgiou
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013285:Strabismus / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed
keywords: Conjugate eye deviation; Ischemic brain injury; Prevost’s sign; Stroke