Clinical implications of eye deviation on admission CT examination of acute ischaemic stroke patients.
OBJECTIVE
To determine the frequency and prognostic value of eye deviation detected on the admission computed tomography (CT) of acute ischaemic stroke patients.


METHODS
The clinical and imaging data from the Albumin in Acute Stroke (ALIAS) Trials 1 and 2 were analysed. Two reviewers evaluated all admission CT images for the presence of eye deviation, and Alberta Stroke Program Early CT Score (ASPECTS). The admission National Institutes of Health Stroke Scale (NIHSS) scores and 3-month modified Rankin scale (mRs) scores were ascertained. Disability or death was defined as mRS score >2, at 3-month follow-up.


RESULTS
Of 1,223 patients included in the present series, 352 (28.8%) had rightward and 331 (27.1%) had leftward eye deviation on admission CT. Patients with eye deviation on CT had higher admission NIHSS score and larger middle cerebral artery (MCA) territory infarct volume (based on ASPECTS). The presence of eye deviation on CT was associated with higher rates of haemorrhagic transformation at 24 hours (19.8% versus 13.5%, p=0.004), and higher rates of disability or death at 3-month follow-up (53.1% versus 35.7%, p<0.001). Mediation analysis showed that radiological eye deviation relation with higher rate of disability or death is predominantly due to its association with higher admission NIHSS scores, lower ASPECTS, and to a lesser extent patients' older age.


CONCLUSIONS
The presence of eye deviation on CT examination of acute ischaemic stroke patients is associated with larger anterior circulation stroke volumes, higher risk of 24-hour haemorrhagic transformation, and 3-month disability or death.
Zeenat Qureshi Stroke Institute, St Cloud, MN, USA; Department of Radiology, University of Minnesota, Minneapolis, MN, USA.
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Payabvash
Zeenat Qureshi Stroke Institute, St Cloud, MN, USA.
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Qureshi
Zeenat Qureshi Stroke Institute, St Cloud, MN, USA. Electronic address: qureshai@gmail.com.
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Qureshi
D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D005123:Eye / Q000503:physiopathology*; D005260:Female; D005403:Fixation, Ocular / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed / Q000379:methods*