Conjugate Eye Deviation in Unilateral Lateral Medullary Infarction
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Purpose The initial diagnosis of medullary infarction can be challenging since CT and even MRI results in the very acute phase are often negative. Methods A retrospective, observer-blinded study of horizontal conjugate eye deviation was performed in 1) 50 consecutive patients [age 58±15 years (mean±SD), 74% male, National Institutes of Health Stroke Scale 2±1] with acute unilateral lateral medullary infarction as seen in MRI (infarction group), 2) 54 patients with transient brainstem symptoms [transient ischemic attack of brainstem (TIA) group; age 69±16 years, 59% male], and 3) 53 patients (age 59±20 years, 49% male) with diagnoses other than stroke (control group). Results Conjugate eye deviation was found in all patients in the infarction group [n=47 (94%) with ipsilesional deviation and n=3 (6%) with contralesional deviation] compared to 41% (n=22) in the brainstem TIA group and 15% (n=8) in the control group (p<0.0001). Within all groups mean deviation and range were similar for both sides (to the right vs. to the left side 26.6°±12.3 vs. 26.1°±12.3 in the infarction group, 10.5°±5.8 vs. 8.4°±6.3 in the brainstem TIA group and 4.5°±3.2 vs. 7.5°±3.2 in the control group). The extent of eye deviation was significantly greater in the infarction group (p<0.05). Conclusions All patients with MRI-demonstrated unilateral medullary infarction showed conjugate eye deviation. Therefore, conjugate eye deviation in patients with suspected acute lateral medullary infarction is a helpful sensitive sign for supporting the diagnosis, particularly if the deviation is >20°.
Abstract
Background and Purpose The initial diagnosis of medullary infarction can be challenging since CT and even MRI results in the very acute phase are often negative. Methods A retrospective, observer-blinded study of horizontal conjugate eye deviation was performed in 1) 50 consecutive patients [age 58±15 years (mean±SD), 74% male, National Institutes of Health Stroke Scale 2±1] with acute unilateral lateral medullary infarction as seen in MRI (infarction group), 2) 54 patients with transient brainstem symptoms [transient ischemic attack of brainstem (TIA) group; age 69±16 years, 59% male], and 3) 53 patients (age 59±20 years, 49% male) with diagnoses other than stroke (control group). Results Conjugate eye deviation was found in all patients in the infarction group [n=47 (94%) with ipsilesional deviation and n=3 (6%) with contralesional deviation] compared to 41% (n=22) in the brainstem TIA group and 15% (n=8) in the control group (p<0.0001). Within all groups mean deviation and range were similar for both sides (to the right vs. to the left side 26.6°±12.3 vs. 26.1°±12.3 in the infarction group, 10.5°±5.8 vs. 8.4°±6.3 in the brainstem TIA group and 4.5°±3.2 vs. 7.5°±3.2 in the control group). The extent of eye deviation was significantly greater in the infarction group (p<0.05). Conclusions All patients with MRI-demonstrated unilateral medullary infarction showed conjugate eye deviation. Therefore, conjugate eye deviation in patients with suspected acute lateral medullary infarction is a helpful sensitive sign for supporting the diagnosis, particularly if the deviation is >20°.
참고문헌 (12)
- Bryan RN, "Diagnosis of acute cerebral infarction : comparison of CT and MR imaging", AJNR Am J Neuroradiol, 12, pp.611~620 (1991)
- Sylaja PN, "When to expect negative diffusion-weighted images in stroke and transient ischemic attack", Stroke, 39, pp.1898~1900 (2008)
- Singer OC, "Conjugate eye deviation in acute stroke : incidence, hemispheric asymmetry, and lesion pattern", Stroke, 37, pp.2726~2732 (2006)
- Ringman JM, "Hemispheric asymmetry of gaze deviation and relationship to neglect in acute stroke", Neurology, 65, pp.1661~1662 (2005)
- Kim JS, "Ocular lateropulsion in Wallenberg syndrome", Neurology, 62, pp.2287~ (2004)
- Crevits L, "Ocular lateropulsion in Wallenberg’s syndrome : a prospective clinical study", Acta Neurol Scand, 65, pp.219~222 (1982)
- Kattah JC, "Ocular lateropulsion as a central oculomotor sign in acute vestibular syndrome is not posturally dependent", Ann N Y Acad Sci, 1233, pp.249~255 (2011)
- Dieterich M, "Wallenberg’s syndrome : lateropulsion, cyclorotation, and subjective visual vertical in thirty-six patients", Ann Neurol, 31, pp.399~408 (1992)
- Kim JS, "Pure lateral medullary infarction : clinical-radiological correlation of 130 acute, consecutive patients", Brain, 126, pp.1864~1872 (2003)
- Solomon D, "Possible mechanisms for horizontal gaze deviation and lateropulsion in the lateral medullary syndrome", J Neuroophthalmol, 15, pp.26~30 (1995)
- Nishimura K, "Radiographic conjugate horizontal eye deviation in patients with acute cerebellar infarction", J Neurol Sci, 355, pp.68~71 (2015)
- Ogawa T, "Conjugate eye deviation caused by upper medial medullary infarction : a case report", J Stroke Cerebrovasc Dis, 27, pp.e221~e223 (2018)[DOI]