Department of Neurology and Stroke Center, Hiratsuka Kyosai Hospital, Hiratsuka, Japan.
J Neurol Sci. 2011 Sep 15;308(1-2):165-7. doi: 10.1016/j.jns.2011.06.010. Epub 2011 Jun 25.
Supratentorial stroke can cause conjugate eye deviation directed contralateral to the affected side (wrong-way deviation). It is rare and thought to be associated exclusively with hemorrhagic stroke. We prospectively investigated the clinical features and prognostic significance of this wrong-way deviation.
Subjects were 12 patients who manifested wrong-way deviation subsequent to supratentorial stroke. These patients were from a group of 968 consecutive patients hospitalized for acute supratentorial stroke during the period April 2007 through March 2010. Clinical features of wrong-way deviation were evaluated.
The overall incidence of wrong-way deviation was 1.2%. The causative lesion was a huge intracranial hemorrhage (n=7) or an extensive hemispheric infarction (n=5). Left-sided lesions were most frequent (66.7% of patients). Wrong-way deviation usually appeared a few days after the initial insult and was frequently accompanied by transient downward eye deviation (58.3% of patients). Although the outcomes for patients treated conservatively were generally poor, patients who underwent surgical decompression regained consciousness.
Wrong-way deviation can result not only from hemorrhagic but also ischemic stroke if the stroke is extensive. Secondary damage to the adjacent rostral brainstem where oculomotor pathways cross over from the contralateral hemisphere can explain the phenomenon, its temporal evolution, and associated eye signs. Immediate surgical decompression may be necessary to improve the prognosis in such cases.
幕上卒中可导致向病变对侧（反常方向）的共轭眼偏斜（反常方向偏斜）。这种情况较为罕见，被认为仅与出血性卒中有关。我们前瞻性研究了这种反常方向偏斜的临床特征和预后意义。
本研究纳入了 12 例幕上卒中后出现反常方向偏斜的患者。这些患者均来自 2007 年 4 月至 2010 年 3 月期间因急性幕上卒中住院的 968 例连续患者。我们对反常方向偏斜的临床特征进行了评估。
反常方向偏斜的总发生率为 1.2%。病因病变为巨大颅内出血（n=7）或广泛半球性梗死（n=5）。左侧病变最常见（66.7%的患者）。反常方向偏斜通常在初始损伤后数天出现，常伴有短暂的向下眼偏斜（58.3%的患者）。尽管保守治疗的患者预后一般较差，但接受手术减压的患者意识恢复。
如果卒中广泛，反常方向偏斜不仅可由出血性卒中引起，也可由缺血性卒中引起。邻近的、展神经通路从对侧半球交叉的颅前脑干部位的继发性损伤可解释这种现象及其时间演变和相关的眼部体征。在这种情况下，可能需要立即进行手术减压以改善预后。
