Highlights
- •Ocular Lateral Deviation, OLD, is a vestibular finding that can be seen in strokes
- •OLD refers to eye deviation that is made worse after brief eye closure
- •OLD is different from gaze palsy in that the eye movements are otherwise full
- •OLD is seen in posterior fossa strokes, most commonly in dorsolateral medulla
Abstract
Background
Posterior circulation stroke can present with dizziness/vertigo without other general
neurological symptoms or signs, making it difficult to detect, and missed stroke can
deteriorate. Therefore, a sign that can be easily identified during an exam would
be helpful to improve the detection of this type of stroke.
Objective of the Review
The objective of this review is to highlight an ocular sign that is seen in posterior
circulation strokes called ocular lateral deviation (OLD). OLD is mostly seen in dorsolateral
medullary strokes, and it is also seen in pontine and cerebellar strokes. OLD is detected
by asking a patient to look straight ahead and then briefly close their eyes. Upon
re-opening their eyes, the examiner will see that the eyes have deviated to one side;
the patient's eyes will then make corrective saccade(s) to return to looking straight
ahead. Complete eye deviation is a central sign of posterior circulation stroke.
Discussion
OLD is an under-recognized vestibular ocular sign of central vestibulopathies including
posterior circulation stroke. Most common location is in dorsolateral medulla where
one third of such strokes have complete OLD. Eye deviation can also be appreciated
on CT or MRI imaging. OLD can be detected up to 6 months after a posterior circulation
stroke.
Conclusions
Checking for the sign of complete eye deviation in patients with dizziness/vertigo
could be a simple, quick method for detecting posterior circulation stroke, and a
means to improving the patients’ outcome.
Keyword
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Article info
Publication history
Accepted:
February 17,
2023
Received in revised form:
January 28,
2023
Received:
September 4,
2022
Publication stage
In Press Accepted ManuscriptFootnotes
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Acknowledgement
We are grateful to Ms. Heather Widmayer's help with manuscript editing
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
