Session: Free papers Session VIII - Graves & Neurologic disease

Ocular gaze palsies due to stroke: profiles and outcomes

Introduction: Ocular gaze palsies arise from a range of neurological/brain injury insults, with many related to microvascular events. The objective of this study is to explore the types and outcomes of gaze palsy that occur following stroke in a UK-based prospective epidemiology study.

Methods: All adult stroke admissions admitted to three acute stroke units over a 15-month period were recruited with orthoptic assessment for stroke survivors able to undergo visual assessment. Full documentation of stroke demographics and orthoptic assessments was captured, including visual acuity, visual fields, visual perception, ocular alignment and motility, and binocular function. Descriptive quantitative analysis was undertaken.

Results: Of 1500 stroke admissions over 15 months; 1204 survived and were assessed by orthoptists. Of 290 with confirmed ocular motility disorders, 97 had gaze palsies. Mean age for those with gaze palsies was 74.94 years (SD 15.04) with 46.5% female and 53.5% male. Stroke was due to infarct in 93% and haemorrhage in the remainder. Stroke severity was assessed using the Barthel Index with mean score of 6.0 (SD 6.86). 73 had horizontal gaze palsy of which 9 were INO and 4 were one and a half syndrome. 24 had vertical gaze palsy of which 11 were upgaze palsy and 9 were downgaze palsy. Gaze palsies often occurred with other visual impairments. All had follow-up assessments with full recovery for 29.1% at mean 51.0 days (SD 48.83), partial recovery for 40.7% and no recovery for the remainder.

Conclusions: In this epidemiology study, incidence and prevalence of CNP in acute stroke survivors was 6.89% and 7.14% respectively. From the sub cohort of ocular motility deficits, incidence and prevalence was 29.62% and 29.65% respectively. Horizontal gaze palsies were more common than vertical gaze palsies. Full recovery was usually over a period of 2 months with partial recovery over a longer period of time. Ocular gaze palsies were seen with more severe strokes.