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 examination
would be helpful to improve the detection of this type of stroke.
Objective
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. 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.
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.
Keywords
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Article info
Publication history
Published online: March 06, 2023
Accepted:
February 17,
2023
Received in revised form:
January 28,
2023
Received:
September 4,
2022
Publication stage
In Press Uncorrected ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
