Wrong-Way Eye Deviation During Eye Opening
Wataru Shiraishi, Yusuke Nakazawa, Yukiko Inamori, Yasutaka Iwanaga, Akifumi Yamamoto

TL;DR
A rare case of eye deviation in a stroke patient shows eyes deviating away from the lesion only when opening, suggesting unique brain pathway involvement.
Contribution
This case highlights a rare 'wrong-way eye deviation' occurring only during eye opening, indicating distinct voluntary and automatic eye movement pathways.
Findings
Eye deviation occurred only during eye opening, not when eyes were closed.
The deviation was away from the left cerebral hemisphere lesion, consistent with 'wrong-way eye deviation'.
The patient's condition suggests selective impairment of the anterior voluntary eye movement pathway.
Abstract
In most cases, eye deviation caused by brain lesions points toward the side of the lesion in supratentorial strokes and away from the lesion in infratentorial strokes. However, in rare cases of supratentorial lesions, the eyes may deviate to the opposite side, a condition known as "wrong-way eye deviation." A woman in her 60s with a history of untreated hypertension and heavy smoking was found unconscious at home and brought to the emergency department. On arrival, she was comatose, with a Glasgow Coma Scale score of 4 (E1V1M2), complete right-sided paralysis, and rightward eye deviation. Notably, her eyes remained in the midline when closed but deviated abruptly to the right when forcibly opened. Imaging revealed a large infarction in the left cerebral hemisphere due to occlusion of the left internal carotid artery, though collateral circulation preserved flow to the left middle…
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Taxonomy
TopicsIntraocular Surgery and Lenses · Visual perception and processing mechanisms · Spatial Neglect and Hemispheric Dysfunction
