Abstract Details

Title Radiographic Horizontal Conjugate Gaze Deviation in Acute Vestibular Syndrome

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P9 - Poster Session 9 (12:00 PM-1:00 PM)

Poster/Presentation
Number 5-004

Objective

We sought to measure the frequency of radiographic horizontal conjugate gaze deviation (h-CGD) in patients with acute vestibular syndrome (AVS).

Background 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.

Design/Methods 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.

Results

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.

Conclusions

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, FAAN (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, FAAN (NorthShore University HealthSystem)	Dr. Pula has nothing to disclose.
David E. Newman-Toker, MD, PhD, FAAN (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.

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