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Abstract Details

Radiographic Horizontal Gaze Deviation in Stroke and Acute Peripheral Vestibulopathy: a Systematic Review
Neuro-ophthalmology/Neuro-otology
P9 - Poster Session 9 (12:00 PM-1:00 PM)
5-008

We sought to summarize literature describing radiographic horizontal gaze deviation (rHGD) in patients with stroke and acute peripheral vestibulopathy (APV).
Radiographic horizontal gaze deviation (rHGD) (i.e., conjugate eye deviation away from the mid-sagittal plane on neuroimaging) is said to correlate with underlying brain or vestibular pathology. However, study results vary. 

Systematic review. We searched databases of Medline, EMBASE, Web of Science, and Cochrane library for studies assessing rHGD in stroke or APV. Case reports were excluded.
Of 1058 citations screened by title or abstract, we read the full text in 34 and included 23 (20 original articles, 3 conference abstracts). Of these 23, 18 focused on anterior circulation strokes, 2 on posterior circulation strokes, 1 on APV, and 1 had a mixed population. 6 studies included control subjects for comparison. rHGD was generally found more frequently in stroke patients compared to APV and healthy subjects. The deviation was generally ipsilesional for anterior circulation strokes and contralesional for posterior circulation strokes. Peripheral vestibulopathy was also associated with rHGD, generally ipsilesional. The presence/severity of rHGD correlated with higher National Institutes of Health stroke scale scores, but not with health outcomes such as morbidity or mortality.
rHGD is more common in stroke and APV than in healthy controls, but it can be ipsilesional or contralesional depending on brain region affected. Since the sign is only evident after imaging is obtained, its presence or absence is generally unlikely to affect bedside diagnostic reasoning or patient management. 
Authors/Disclosures
Shervin Badihian, MD (Cleveland Clinic)
PRESENTER 		Dr. Badihian has nothing to disclose.
Jorge C. Kattah, MD, FÂ鶹´«Ã½Ó³»­ (University of Illinois College of Medicine at Peoria) Dr. Kattah has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Bonezzi, Switzer , Poilitto and Hupp Legal Firm.
David E. Newman-Toker, MD, PhD, FÂ鶹´«Ã½Ó³»­ (Johns Hopkins Unversity School of Medicine, Dept of Neurology) The institution of Dr. Newman-Toker has received research support from NIH, AHRQ, AHA, Moore Foundation. Dr. Newman-Toker has received intellectual property interests from a discovery or technology relating to health care.