Abstract TP304: Conjugate Eye Deviation in Acute Intracerebral Hemorrhage: Stroke Acute Management With Urgent Risk-factor Assessment and Improvement (SAMURAI) -ICH Study

Background and Purpose: Conjugate eye deviation (CED) occurs frequently in patients with acute stroke. The purpose of this study was to elucidate the factors that correlate with CED, as well as the relationship between CED and outcomes, in patients with acute intracerebral hemorrhage (ICH). Methods: A total of 211 patients with acute supratentorial ICH were recruited in a multicenter, prospective study. Both on admission and 72 hours later, CED was assessed with an NIH Stroke Scale “best gaze” subscore of ≥1. Hematoma location and volume were assessed on CT within 2.5 hours of onset. Results: Ninety-six (45%) patients had CED on admission. On multivariable analysis, right-sided lesion (OR 2.36, 95% CI 1.18-4.93), hematoma volume (OR 1.07, 95% CI 1.04-1.10 per 1 mL), and baseline GCS score (OR 0.66, 95% CI 0.53-0.80 per 1 point) were independently associated with CED. After adjusting for sex, age, intraventricular extension of the hematoma, baseline GCS score, and hematoma volume, the presence of CED both on admission and 72 hours later was an independent predictor of death or dependency at 3 months post-stroke (OR 5.77, 95% CI 2.27-16.94). The optimal cutoff volume of hematoma related to CED was ≥13.5 mL for patients with putaminal hemorrhage (sensitivity, 76%; specificity, 72%) and ≥7.7 mL for patients with thalamic hemorrhage (sensitivity, 82%; specificity, 83%). Conclusions: The persistence of CED was a significant predictor of death or dependency after acute supratentorial ICH even after adjusting for initial severity and hematoma volume. CED can be evoked by a relatively smaller thalamic hematoma than a putaminal hematoma. Bedside assessment of CED appears to provide valuable information related to chronic outcomes of patients with ICH.