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Gaze Deviation and Acute Stroke Care Strategies (I6.001)

2016; Lippincott Williams & Wilkins; Volume: 86; Issue: 16_supplement Linguagem: Inglês

10.1212/wnl.86.16_supplement.i6.001

1526-632X

Zaid Mahdi, Anup Kumar Trikannad Ashwini Kumar, Pratik Bhattacharya, Ramesh Madhavan,

Traumatic Brain Injury and Neurovascular Disturbances

Objective: To determine if gaze deviation is a good predictor for large artery occlusions and interventional therapies Background: IV thrombolysis and Mechanical thrombectomy are changing outcomes in acute stroke patients. Acute care strategies to reduce the time of intervention in prehospital and hospital setting can help in the9 Time is brain9 concept of saving brain tissue. Stroke Guideline to improve the 9Time of onset of symptoms to treatment9 has focused on using clinical scales, rapid triage, single call system, imaging, lab, tPA storage and administration protocols. Methods: 167 patients with NIHSS documentation, CTAngiography, Plain CT/MRI brain were analyzed in this IRB approved study. Large artery occlusion was found in 82, while 85 patients with small vessel disease acted as controls. Results: Average age was 68.6 years with 51[percnt] males and 48[percnt] females. 47[percnt] of these patients had large artery occlusions. Abnormal gaze was present in 31[percnt] with a median NIHSS of 20. The median NIHSS was five in patients without eye deviation. Only 6[percnt] had abnormal gaze in patients without large artery occlusion, while 60[percnt] of large artery occlusion patients had gaze palsy. Sensitivity and specificity of gaze deviation to detect a large artery occlusion was 60 and 94[percnt] respectively. Positive predictive value was 90[percnt] and positive likelihood ratio 10. Seventy one percent with gaze deviation received IV tpA and/or mechanical thrombectomy, whereas 32.2[percnt] of those without gaze deviation received acute interventions. (p=0.0001). Conclusions: Gaze deviation is a good predictor of large artery occlusion and if present can positively predict hyperacute interventions. Incorporating their use in prehospital and increasing their weightage in a 9modified9 NIHSS can be used as a strategy to reduce ‘the time of onset of symptoms to treatment’ in hyperacute stroke. Prehospital stroke scales that include gaze deviation sign may be useful in clinical practice. Disclosure: Dr. Mahdi has nothing to disclose. Dr. Trikannad Ashwini Kumar has nothing to disclose. Dr. Bhattacharya has nothing to disclose. Dr. Madhavan has nothing to disclose.