Radiographic horizontal gaze deviation in the setting of acute PICA territory ischemia: A potential mimic of large vessel occlusion

Jiang, Nan; Sahlas, Demetrios J.; Fong, Crystal; Wu, Wei; Monteiro, Sandra; Larrazabal, Ramiro

doi:10.1016/j.jns.2020.117226

Cited by 3 publications

(6 citation statements)

References 23 publications

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“…The cooccurrence perhaps suggests the similarity of the neural mechanisms between PHGD and RHGD. In another article, RHGD was more frequent than PHGD in patients involving large-artery (i.e., ICA or proximal MCA) occlusion or PICA stroke 17 ; however, detailed statistical analyses like those in this study have not been performed for the positivity difference. One of the reasons for the predominant occurrence of RHGD may be the fact that RHGD can be defined objectively by measuring eye deviation angles.…”

Section: Discussionmentioning

confidence: 71%

“…There were relatively few patients with PICA stroke and they were classified as a subgroup irrespective of the causative mechanisms involved, since previous articles reported patients in this subgroup frequently had RHGD. 15,17 In contrast, subgroups of the undetermined causes of MCA infarctions and CAE of multi-territorial infarctions were not analyzed because they had heterogeneous clinical characteristics. Another limitation is that the author measured the eye deviation angles and classified stroke patients; therefore, the classifications might be subject to biases.…”

Section: Discussionmentioning

confidence: 99%

“…The subgroups comprising >30 patients were analyzed considering the number of patients in previous articles. 13,14,16,17…”

Section: Methodsmentioning

confidence: 99%

“…The subgroups comprising >30 patients were analyzed considering the number of patients in previous articles. 13,14,16,17

Figure 1.Measurements of eye deviation angles on computed tomography. For each eye, on the axial slice in which the lens was most clearly identified, a line on the midline of the nasal structures and another line along the long axis of the lens were drawn.…”

Section: Methodsmentioning

confidence: 99%

“…16 RHGD was more prevalent than PHGD in patients with large-vessel occlusion or PICA stroke. 17 However, the relationship has not been analyzed in detail.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Differences between Radiographic and Physical Horizontal Gaze Deviation: Utility of Using the Two in Patients with Ischemic Stroke

Kobayashi

2024

The Neurohospitalist

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Background and Purpose Radiographic horizontal gaze deviation (RHGD) has been identified as a useful finding on computed tomography (CT) that indicates the affected side in supratentorial ischemic stroke; however, it remains unclear whether RHGD is essentially the same phenomenon as physical horizontal gaze deviation (PHGD). To resolve the issue, this study was conducted. Methods Retrospective analyses were performed for 671 patients with ischemic stroke and 142 controls who were hospitalized and underwent head CT. First, clinical findings were examined to find differences between RHGD-positive and RHGD-negative patients. Second, patients were classified by their stroke mechanisms and/or affected vascular territories. For each subgroup, RHGD was compared with PHGD in frequency. Third, the proportions for patients divided by positivity for PHGD and RHGD were calculated in the subgroups. Results Patients with RHGD had PHGD more often than those without. In all stroke subgroups, RHGD was more frequent than PHGD. The frequency difference was prominent in small-artery occlusion (SAO) and posterior inferior cerebellar artery (PICA) stroke. In SAO of the basilar artery pontine perforator, RHGD was positive in 25% and largely contralesionally-directed. In PICA stroke, lesions in the vestibulocerebellum were associated with contralesional RHGD. Moreover, lesions in the lateral medulla also caused RHGD, which was mainly directed to the ipsilesional side. PHGD-positive stroke without RHGD was infrequent, whereas RHGD-positive stroke without PHGD was commonly observed (PICA stroke, 45.9%; other subgroups, 21.1%-27.5%). Conclusions RHGD had different characteristics from PHGD; therefore, assessments of both PHGD and RHGD may lead to more accurate diagnoses.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

“…The subgroups comprising >30 patients were analyzed considering the number of patients in previous articles. 13,14,16,17…”

Section: Methodsmentioning

confidence: 99%

“…The subgroups comprising >30 patients were analyzed considering the number of patients in previous articles. 13,14,16,17

Section: Methodsmentioning

confidence: 99%

“…16 RHGD was more prevalent than PHGD in patients with large-vessel occlusion or PICA stroke. 17 However, the relationship has not been analyzed in detail.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical Differences between Radiographic and Physical Horizontal Gaze Deviation: Utility of Using the Two in Patients with Ischemic Stroke

Kobayashi

2024

The Neurohospitalist

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Assessment of vertical component of gaze deviation in acute PICA occlusion on Computed Tomography

Jiang

2021

Journal of the Neurological Sciences

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Multimodal monitoring: practical recommendations (dos and don'ts) in challenging situations and uncertainty

et al. 2023

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With the advancements in modern medicine, new methods are being developed to monitor patients in the intensive care unit. Different modalities evaluate different aspects of the patient's physiology and clinical status. The complexity of these modalities often restricts their use to the realm of clinical research, thereby limiting their use in the real world. Understanding their salient features and their limitations can aid physicians in interpreting the concomitant information provided by multiple modalities to make informed decisions that may affect clinical care and outcomes. Here, we present a review of the commonly used methods in the neurological intensive care unit with practical recommendations for their use.

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Radiographic horizontal gaze deviation in the setting of acute PICA territory ischemia: A potential mimic of large vessel occlusion

Cited by 3 publications

References 23 publications

Clinical Differences between Radiographic and Physical Horizontal Gaze Deviation: Utility of Using the Two in Patients with Ischemic Stroke

Clinical Differences between Radiographic and Physical Horizontal Gaze Deviation: Utility of Using the Two in Patients with Ischemic Stroke

Assessment of vertical component of gaze deviation in acute PICA occlusion on Computed Tomography

Multimodal monitoring: practical recommendations (dos and don'ts) in challenging situations and uncertainty

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