Skip to main content
SpringerLink
Log in

Dynamic changes of the direction and angle of radiographic ocular lateral deviation in patients with lateropulsion after stroke onset

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Objective

To examine if radiographic ocular lateral deviation (rOLD) could be provoked in stroke patients with mild-to-moderate lateropulsion according to vertical perception.

Methods

In this single-center, retrospective study, acute stroke patients with mild-to-moderate lateropulsion assessed by the Scale for Contraversive Pushing were enrolled. Computed tomography or magnetic resonance imaging was performed on all patients on admission and then according to their conditions. The direction and angle of rOLD were compared among three groups according to the responsible lesion: lateral medullary (LM), pontine (P), and hemispheric (H).

Results

Sixty-six patients (male, 47; average age, 67 years) were enrolled and divided into the LM (n = 37), P (n = 8), and H (n = 21) groups. All patients had body tilt. Patients in the LM group showed body tilt to the ipsilesional side during hospitalization, while those in the P and H groups tilted to the contralesional side. All patients had rOLD at the final assessment at an average of 13 days after onset; patients in the P and H groups showed contralateral rOLD, while those in the LM group showed ipsilateral rOLD if they did not have cerebellar or pontine lesions. Significant decreases in the angle and changes in direction of rOLD according to lesion site were observed during hospitalization.

Conclusion

Serial changes in rOLD findings after stroke onset are different according to the responsible lesion. The direction of rOLD in most patients is in accordance with vertical perception after the acute stage of stroke.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

All data are available from the corresponding author upon reasonable request.

References

  1. Thömke F, Marx JJ, Iannetti GD, Cruccu G, Fitzek S, Urban PP, Stoeter P, Dieterich M, Hopf HC (2005) A topodiagnostic investigation on body lateropulsion in medullary infarcts. Neurology 64:716–718

    Article  PubMed  Google Scholar 

  2. Bjerver K, Silfverskiöld BP (1968) Lateropulsion and imbalance in Wallenberg’s syndrome. Acta Neurol Scand 44:91–100

    Article  CAS  PubMed  Google Scholar 

  3. Hörnsten G (1974) Wallenberg’s syndrome. I. General symptomatology, with special reference to visual disturbances and imbalance. Acta Neurol Scand 50:434–446

    Article  PubMed  Google Scholar 

  4. Yi HA, Kim HA, Lee H, Baloh RW (2007) Body lateropulsion as an isolated or predominant symptom of a pontine infarction. J Neurol Neurosurg Psychiatry 78:372–374

    Article  PubMed  Google Scholar 

  5. Baehring JM, Phipps M, Wollmann G (2008) Rostral midbrain infarction producing isolated lateropulsion. Neurology 70:655–656

    Article  PubMed  Google Scholar 

  6. Lee H (2006) Isolated body lateropulsion caused by a lesion of the rostral vermis. J Neurol Sci 249:172–174

    Article  PubMed  Google Scholar 

  7. Masdeu JC, Gorelick PB (1988) Thalamic astasia: inability to stand after unilateral thalamic lesions. Ann Neurol 23:596–603

    Article  CAS  PubMed  Google Scholar 

  8. Pérennou DA, Amblard B, Leblond C, Pélissier J (1998) Biased postural vertical in humans with hemispheric cerebral lesions. Neurosci Lett 252:75–78

    Article  PubMed  Google Scholar 

  9. Dieterich M, Brandt T (1993) Ocular torsion and tilt of subjective visual vertical are sensitive brainstem signs. Ann Neurol 33:292–299

    Article  CAS  PubMed  Google Scholar 

  10. Brandt T, Dieterich M (1994) Vestibular syndromes in the roll plane: topographic diagnosis from brainstem to cortex. Ann Neurol 36:337–347

    Article  CAS  PubMed  Google Scholar 

  11. Brandt T, Dieterich M (2017) The dizzy patient: don’t forget disorders of the central vestibular system. Nat Rev Neurol 13:352–362

    Article  PubMed  Google Scholar 

  12. Dai S, Pérennou D (2021) Renaissance of “lateropulsion.” Ann Phys Rehabil Med 64:101595

    Article  PubMed  Google Scholar 

  13. Horak FB (2006) Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing 35(Suppl 2):ii7–ii11

    Article  PubMed  Google Scholar 

  14. Dakin CJ, Rosenberg A (2018) Gravity estimation and verticality perception. Handb Clin Neurol 159:43–59

    Article  PubMed  PubMed Central  Google Scholar 

  15. Diaz-Artiles A, Karmali F (2021) Vestibular precision at the level of perception, eye movements, posture, and neurons. Neuroscience 468:282–320

    Article  CAS  PubMed  Google Scholar 

  16. Barra J, Marquer A, Joassin R, Reymond C, Metge L, Chauvineau V, Pérennou D (2010) Humans use internal models to construct and update a sense of verticality. Brain 133:3552–3563

    Article  PubMed  Google Scholar 

  17. Dai S, Lemaire C, Piscicelli C, Perennou D (2022) Lateropulsion prevalence after stroke: a systematic review and meta-analysis. Neurology 98:e1574–e1584

    Article  CAS  PubMed  Google Scholar 

  18. Dai S, Piscicelli C, Clarac E, Baciu M, Hommel M, Perennou D (2021) Balance, lateropulsion, and gait disorders in subacute stroke. Neurology 96:e2147–e2159

    Article  PubMed  Google Scholar 

  19. Baloh RW, Yee RD, Honrubia V (1981) Eye movements in patients with Wallenberg’s syndrome. Ann N Y Acad Sci 374:600–613

    Article  CAS  PubMed  Google Scholar 

  20. Waespe W, Wichmann W (1990) Oculomotor disturbances during visual-vestibular interaction in Wallenberg’s lateral medullary syndrome. Brain 113(Pt 3):821–846

    Article  PubMed  Google Scholar 

  21. Frisén L (1978) Lateropulsion of the eyes–a localizing brainstem sign. J Neurol 218:171–177

    Article  PubMed  Google Scholar 

  22. Kattah JC, Badihian S, Pula JH, Tarnutzer AA, Newman-Toker DE, Zee DS (2020) Ocular lateral deviation with brief removal of visual fixation differentiates central from peripheral vestibular syndrome. J Neurol 267:3763–3772

    Article  PubMed  PubMed Central  Google Scholar 

  23. Platti N, Fakih R, Maley J, Deniz K, Agac B, Fattal D (2022) Ocular lateral deviation as a vestibular clinical sign of medial posterior inferior cerebellar artery strokes: a case report. J Stroke Cerebrovasc Dis 31:106618

    Article  CAS  PubMed  Google Scholar 

  24. Pierrot-Deseilligny C, Amarenco P, Roullet E, Marteau R (1990) Vermal infarct with pursuit eye movement disorders. J Neurol Neurosurg Psychiatry 53:519–521

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Crane BT, Tian J, Demer JL (2000) Asymmetry of ocular motor and perceptual vestibular processing in humans with unilateral vestibular deafferentation. J Vestib Res 10:259–269

    Article  CAS  PubMed  Google Scholar 

  26. Yang YJ, Kim KW, Choi JE, Lee MY, Yoo DS, Jung JY (2018) Prediction of vestibular imbalance in acute peripheral vestibulopathy by measuring horizontal ocular deviation on magnetic resonance imaging. Otol Neurotol 39:e108–e112

    Article  PubMed  Google Scholar 

  27. Karnath HO, Ferber S, Dichgans J (2000) The origin of contraversive pushing: evidence for a second graviceptive system in humans. Neurology 55:1298–1304

    Article  CAS  PubMed  Google Scholar 

  28. Duncan PW, Jorgensen HS, Wade DT (2000) Outcome measures in acute stroke trials: a systematic review and some recommendations to improve practice. Stroke 31:1429–1438

    Article  CAS  PubMed  Google Scholar 

  29. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864–870

    Article  CAS  PubMed  Google Scholar 

  30. Coffman CR, Raman R, Ernstrom K, Herial NA, Schlick KH, Rapp K, Modir RF, Meyer DM, Hemmen TM, Meyer BC (2015) The “DeyeCOM Sign”: predictive value in acute stroke code evaluations. J Stroke Cerebrovasc Dis 24:1299–1304

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bates D, Mächler M, Bolker B, Walker S (2015) Fitting linear mixed-effects models using lme4. J Stat Softw 67:1–48

    Article  Google Scholar 

  32. Lenth R, Singmann H, Love J, Buerkner P (2023) Herve Memmeans: estimated marginal means, AKA least-squares means.

  33. Dieterich M, Brandt T (1992) Wallenberg’s syndrome: lateropulsion, cyclorotation, and subjective visual vertical in thirty-six patients. Ann Neurol 31:399–408

    Article  CAS  PubMed  Google Scholar 

  34. Teufel J, Strupp M, Linn J, Kalla R, Feil K (2019) Conjugate eye deviation in unilateral lateral medullary infarction. J Clin Neurol 15:228–234

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nishimura K, Ohara T, Nagatsuka K, Minematsu K, Toyoda K (2015) Radiographic conjugate horizontal eye deviation in patients with acute cerebellar infarction. J Neurol Sci 355:68–71

    Article  PubMed  Google Scholar 

  36. Solomon D, Galetta SL, Liu GT (1995) Possible mechanisms for horizontal gaze deviation and lateropulsion in the lateral medullary syndrome. J Neuroophthalmol 15:26–30

    Article  CAS  PubMed  Google Scholar 

  37. Dai S, Piscicelli C, Clarac E, Baciu M, Hommel M, Perennou D (2021) Lateropulsion after hemispheric stroke: a form of spatial neglect involving graviception. Neurology 96:e2160–e2171

    Article  PubMed  Google Scholar 

  38. Tijssen CC, van Gisbergen JA, Schulte BP (1991) Conjugate eye deviation: side, site, and size of the hemispheric lesion. Neurology 41:846–850

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Yoshiaki Morita, M.D., Ph.D., Kenichi Irie, M.D., and Yuji Takenaka, P.T. for their helpful comments.

Funding

This study was supported by the Intramural Research Fund of the National Cerebral and Cardiovascular Center (21-1-4) and a Grant-in-Aid for Scientific Research from the Ministry of Education, Science, and Culture of Japan (JSPS KAKENHI Grant Number 23K10578).

Author information

Authors and Affiliations

  1. Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan

    Masatoshi Kamada, Chiaki Yokota, Daishi Doda & Hiroaki Nishizono

  2. Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan

    Shunsuke Murata & Kunihiro Nishimura

Authors
  1. Masatoshi Kamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chiaki Yokota
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shunsuke Murata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daishi Doda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kunihiro Nishimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroaki Nishizono
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MK and CY researched the literature and conceived the study. CY was involved in protocol development and gaining ethical approval. MK, DD, and HN were involved in patient recruitment, and SM and KN analyzed the data. MK wrote the first draft of the manuscript. CY reviewed and edited the manuscript, and all the authors approved the final version of the manuscript.

Corresponding author

Correspondence to Chiaki Yokota.

Ethics declarations

Conflicts of interest

The authors have no conflicts of interest to declare.

Ethical approval

This study was approved by the Ethics Committee of the National Cerebral and Cardiovascular Center (M28-063-15) and registered with the UMIN Clinical Trials Registry (ID: UMIN000024655). Informed consent was obtained from all the participants.

Ethical standards

This study was conducted in accordance with the Declaration of Helsinki and the Ethical Guidelines on Clinical Studies of the Ministry of Health, Labour and Welfare of Japan.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kamada, M., Yokota, C., Murata, S. et al. Dynamic changes of the direction and angle of radiographic ocular lateral deviation in patients with lateropulsion after stroke onset. J Neurol 270, 4041–4048 (2023). https://doi.org/10.1007/s00415-023-11755-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-023-11755-6

Keywords

Search

Navigation