Tijssen C C
Department of Neurology, St Elisabeth Hospital, Tilburg, The Netherlands.
Stroke. 1994 Jul;25(7):1516-9. doi: 10.1161/01.str.25.7.1516.
Conjugate eye deviation (CED) in patients with acute supratentorial lesions is generally directed ipsilateral to the lesioned hemisphere. Incidentally, CED occurs to the contralateral side. We report five new cases and review previously published reports to elucidate the lesion responsible for and the mechanism underlying this phenomenon.
In a prospective study of 133 consecutive patients with CED caused by an acute supratentorial lesion, 5 patients showed contralateral CED. This was caused by an intracerebral hemorrhage located thalamic (n = 2), frontoparietal (n = 1), and frontoparietotemporal (n = 1). In 1 patient the cause was a subdural hematoma, an association that has not been reported earlier. Four of the 5 patients died. All patients had clinical signs of rostral brain stem dysfunction and a shift of midline structures on computed tomographic scan or at autopsy.
Contralateral CED is always associated with hemorrhagic lesions, most commonly in the thalamus. The prognosis of patients with this sign is generally poor. Involvement of descending oculomotor pathways from the contralateral hemisphere at midbrain level is the most probable explanation for this phenomenon.
急性幕上病变患者的共轭性眼球偏斜（CED）通常指向病变半球的同侧。偶然情况下，CED会出现在对侧。我们报告5例新病例，并回顾先前发表的报告，以阐明导致这种现象的病变及潜在机制。
在一项对133例由急性幕上病变引起CED的连续患者的前瞻性研究中，5例患者出现对侧CED。其病因分别为丘脑脑出血（2例）、额顶叶脑出血（1例）和额顶颞叶脑出血（1例）。1例患者的病因是硬膜下血肿，这种关联此前未见报道。5例患者中有4例死亡。所有患者均有脑桥上段功能障碍的临床体征，且在计算机断层扫描或尸检时可见中线结构移位。
对侧CED总是与出血性病变相关，最常见于丘脑。有此体征的患者预后通常较差。最可能的解释是中脑水平来自对侧半球的动眼神经下行通路受累。
