The Sustained DeyeCOM Sign as a Predictor of Large Vessel Occlusions and Stroke Mimics

Abstract

DeyeCOM(++) had 100% specificity for large vessel occlusion, whereas DeyeCOM(--) had a 100% specificity for absence of large vessel occlusion. Sustained DeyeCOM, whether positive or negative, is a strong predictor of ultimate diagnosis that could lead to quicker endovascular treatment times.

Emerging Detection Techniques for Large Vessel Occlusion Stroke: A Scoping Review

“…Gaze deviation is identified in the NIHSS score and has shown good specificity in a previous study for AIS (71). The DeyeCOM sign study noted a specificity of 100% and sensitivity of 80% for DeyeCOM(++) patients (patients with conjugate gaze deviation on both NCCT and CTA images) and a specificity of 100% and sensitivity of 86% for DeyeCOM(-) patients (absence of DeyeCOM sign on both scans) (66). These results suggest that sustained DeyeCOM(++) and DeyeCOM(-) are strong predictors of anterior LVO stroke presence and absence.…”

“…These results suggest that sustained DeyeCOM(++) and DeyeCOM(-) are strong predictors of anterior LVO stroke presence and absence. DeyeCOM(-) patients often had lower mean NIHSS scores than LVO patients, suggesting DeyeCOM sign can accurately identify LVO stroke from stroke mimics (66).…”

“…Out of the 5 studies observing stand-alone physical symptoms included in this review, 2 studies focused on eye deviation (66,67), 1 study focused on cortical symptoms ( 68), 1 study focused on complete hemiplegia (69), and 1 study focused on neurological symptoms for predicting LVO (70).…”

“…Of the 2 studies focusing on eye deviation (66, 67), 1 study observed for conjugate eye deviation (DeyeCOM sign) on CTA and NCCT (66), which may help to identify stroke patients with cortical deficits. Gaze deviation is identified in the NIHSS score and has shown good specificity in a previous study for AIS (71).…”

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

“…In our series, radiological HGD was observed less often in patients with acute PICA occlusions (43.5%) than in acute LVO (63.2%). In anterior circulation stroke, even a small area of ischemia may result in gaze deviation, if it affects the cortical regions controlling voluntary eye movement, including the frontal eye fields (FEF, Brodmann area), basal ganglia, parietal eye fields, and neighboring temporoparietal cortical regions [7][8][9]. Gaze deviation in PICA territory strokes may be attributed to ischemia in the flocculonodular lobe, vermis, and lateral medulla [10][11][12][13][14][15][16]20].…”