Selected Topics: Neurological Emergencies|Articles in Press

Ocular Lateral Deviation as a Vestibular Sign to Improve Detection of Posterior Circulation Strokes: A Review of the Literature

  • Deema Fattal
    Reprint Address: Deema Fattal, MD, Neurology Department, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242
    Neurology Department, University of Iowa Health Care, Iowa City, Iowa

    Iowa City VA Medical Center, Iowa City, Iowa
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  • Nicole Platti
    University of Iowa Carver College of Medicine, Iowa City, Iowa

    (Present Institution) Neurology Department, University of South Florida, Tampa, Florida
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      • 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.



      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 examination would be helpful to improve the detection of this type of stroke.


      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.


      OLD is an under-recognized vestibular ocular sign of central vestibulopathies including posterior circulation stroke. The most common location is in the dorsolateral medulla, where one-third of such strokes have complete OLD. Eye deviation can also be appreciated on computed tomography or magnetic resonance imaging. OLD can be detected up to 6 months after a posterior circulation stroke.


      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.


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