Conjugate Eye Deviation in Capsulo-Ganglionic Bleed

CT BRAIN showing left capsulo-ganglionic blled

49-year old man presented with right-sided weakness of six hours duration. He was hypertensive and his BP at admission to ER was 200/120 mmHg. He had conjugate eye deviation (CED) to the left side and right sided horizontal gaze paresis. He had right hemiplegia with grade 0/5 power in right upper and lower limbs. Noncontrast CT scan of brain showed left-sided capsulo-ganglionic hematoma with mild mass effect.

Conjugate eye deviation (CED) and horizontal gaze paresis can occur with lesions of frontal eye field, subcortical structures, capsulo-ganglionic region, thalamus and pons. CED occurs to the side of lesion in all the above except for pons, where the deviation occurs to the opposite side of lesion. Among patients with capsulo-ganglionic and thalamic bleeds, about one third develop CED.

CED is a significant predictor for death and disability after three months following supratentorial hemorrhage. Other factors associated with a poor outcome after ICH are larger hematoma volume, intraventricular extension of hematoma and low GCS score.

Published by Dr Sudhir Kumar MD (Medicine) DM (Neurology)

I am a doctor with 25 years experience. I have worked as a neurologist for about 20 years. Educating public and healthcare professionals is very dear to me. This is possible due to my interactions with thousands of patients and their caregivers. I salute the patients who suffer and it is our duty to minimise suffering by preventing diseases and ensuring prompt diagnosis and treatment of those already affected.

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