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Abstract Details

Radiographic Horizontal Conjugate Gaze Deviation in Acute Vestibular Syndrome
Neuro-ophthalmology/Neuro-otology
P9 - Poster Session 9 (12:00 PM-1:00 PM)
5-004

We sought to measure the frequency of radiographic horizontal conjugate gaze deviation (h-CGD) in patients with acute vestibular syndrome (AVS).
Differentiating the peripheral and central causes of acute vestibular syndrome (AVS) could be challenging. Radiographic horizontal conjugate gaze deviation (h-CGD) has been briefly studied as a sign in posterior-fossa stroke and AVS, but not compared to each other as a differentiating factor.
We assessed neuroimaging evidence of supine h-CGD in 143 patients with AVS (central and peripheral localization) and 20 control cases. Radiographic h-CGD was defined by the angle between a line bisecting the lens in each eye and a line perpendicular to the head axis. Diagnostic application of radiographic h-CGD was evaluated in the context of clinical findings.

Overall, 92 cases (64.3%) were diagnosed with a central cause (78 stroke and 14 other central diseases). Peripheral cases had greater average CGD compared to central and control group (21±10.3, 13.5±11.2, and 6.4±3.6, respectively; p<0.001). Also, they had smaller absolute degree separation (ADS) compared to central and control cases (5.1±4.3, 8.7±7.2, and 9.3±10.9, respectively; p=0.009). We could not identify any cut-off points with high diagnostic value. Peripheral cases tended to have more conjugate visual axis compared to central subjects (p=0.045). CGD was ipsilesional in most peripheral cases as well as cerebellar lesions.

Radiographic h-CGD is present in AVS patients as well as healthy individuals, but with greater degrees in peripheral and central localization, respectively. Radiographic h-CGD could not be used as a reliable diagnostic tool and interpretation of such findings should be made more cautiously.
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.
John Pula, MD, FÂ鶹´«Ã½Ó³»­ (NorthShore University HealthSystem) Dr. Pula has nothing to disclose.
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.