Lateral deviation of the eyes on forced lid closure in patients with cerebral lesions
H. C. Sullivan, H. J. Kaminski, E. F. Maas, J. D. Weissman and R. J. Leigh
Department of Neurology, University Hospitals of Cleveland, OH 44106.
We examined 35 patients with unilateral cerebral lesions to determine the
incidence of lateral deviation of the eyes under forcefully closed lids and
the reliability of this sign in predicting the side of the lesion. Only
patients with radiologically confirmed unilateral lesions were studied.
Over 70% of patients had contralateral ocular deviation (Cogan's
"spasticity of conjugate gaze"), 20% had ipsilateral deviation, and less
than 9% of the patients had no deviation. Lateral ocular deviation was as
sensitive, but not as specific, as a unilateral Babinski plantar response
in determining the side with the lesion. Contralateral deviation was more
common with parietotemporal localization, suggesting that the phenomenon
reflects an underlying disturbance of attentional mechanisms.