Conjugate eye deviation as predictor of acute cortical and subcortical ischemic brain lesions

• Infarct signs on non-enhanced computed tomography (NECT) detect stroke poorly.
• Ocular gaze deviation (OGD) >14° on NECT is related to increased risk of stroke.
• OGD >14° has higher sensitivity and negative predictive value than infarct signs.

ObjectivesNon-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.Patients and methodsPatients 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.Results73 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).ConclusionIn the presence of stroke symptoms, average OGD >14° on the initial brain NECT is early predictor of ischemic brain injury.