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Table of Contents    
LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 3  |  Page : 343-344

The eyes in the scanner: Latent conjugate eye deviation


Kessler Foundation Research Center, West Orange, NJ 07052, USA

Date of Submission14-Mar-2012
Date of Decision17-Apr-2012
Date of Acceptance28-Apr-2012
Date of Web Publication14-Jul-2012

Correspondence Address:
Abhijit Das
Kessler Foundation Research Center, West Orange, NJ 07052
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.98536

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How to cite this article:
Das A, Chen P. The eyes in the scanner: Latent conjugate eye deviation. Neurol India 2012;60:343-4

How to cite this URL:
Das A, Chen P. The eyes in the scanner: Latent conjugate eye deviation. Neurol India [serial online] 2012 [cited 2022 Sep 27];60:343-4. Available from: https://www.neurologyindia.com/text.asp?2012/60/3/343/98536


Sir,

A 48-year-old man presented with acute-onset left hemiparesis. Computed tomography (CT) scan revealed hemorrhage in the right fronto-parietal region [Figure 1]a. Although there was no sustained gaze deviation on neurological examination, the CT scan showed a 32 degree rightward conjugate eye deviation (CED) [Figure 1]b. A subsequent evaluation revealed left-sided spatial neglect: a deficit in attention and awareness toward the left space [Figure 2].
Figure 1: Non-contrast axial computed tomography images. (a) Hemorrhage in the right frontoparietal region and (b) conjugate eye deviation (32 degree) toward the right (ipsilesional) side

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Figure 2: Spatial neglect presented in standard neuropsychological assessments: left-sided omission and right-sided bias in (a) line cancellation, (b) line bisection, (c) clock drawing and (d) Figure copying

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This neuroimage presents a classical case of latent CED that helped identify an important neurological deficit. Latent CED can manifest during brain scans, as darkness and/or closing eyes removes the fixation that can mask CED. [1] CED is found to be present in approximately 20% of the patients with stroke. [2] Selective dysfunction of cortical areas involved in spatial attention and eye movements can cause CED. [3] In supratentorial stroke, CED is directed almost exclusively toward the affected hemisphere and is, in a subset of patients, accompanied by ipsilateral deviation of the head. Ipsilesional CED is strongly associated with spatial neglect. [1],[3] Recognizing this "radiological" eye sign, therefore, should help clinicians identify additional neurological deficits.


  Acknowledgments Top


Dr Das receives research support from National Institute on Disability and Rehabilitation Research (H133P090009 - fellow in training, PI: Chiaravalloti). Dr Chen receives research support from the Kessler Foundation and NIH/NINDS (R01NS055808; PI: Barrett).

 
  References Top

1.Becker E, Karnath H-O. Neuroimaging of eye position reveals spatial neglect. Brain 2010;133:909-14.  Back to cited text no. 1
    
2.Singer OC, Humpich MC, Laufs H, Lanfermann H, Steinmetz H, Neumann-Haefelin T. Conjugate eye deviation in acute stroke: incidence, hemispheric asymmetry, and lesion pattern. Stroke. 2006;37:2726-32.   Back to cited text no. 2
    
3.Simon JE, Morgan SC, Pexman JH, Hill MD, Buchan AM. CT assessment of conjugate eye deviation in acute stroke. Neurology 2003;60:135-137.  Back to cited text no. 3
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