| Content Provider |
World Health Organization (WHO)-Global Index Medicus |
| Author |
Coffman, Clarity R. Raman, Rema Ernstrom, Karin Herial, Nabeel A. Schlick, Konrad H. Rapp, Karen Modir, Royya F. Meyer, Dawn M. Hemmen, Thomas M. Meyer, Brett C. |
| Description |
Author Affiliation: Coffman CR ( Department of Neurosciences, University of California, San Diego, California. Electronic address: ccoffman@ucsd.edu.); Raman R ( Department of Family and Preventive Medicine, University of California, San Diego, California.); Ernstrom K ( Department of Family and Preventive Medicine, University of California, San Diego, California.); Herial NA ( Department of Neurosciences, University of California, San Diego, California.); Schlick KH ( Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California.); Rapp K ( Department of Neurosciences, University of California, San Diego, California.); Modir RF ( Department of Neurosciences, University of California, San Diego, California.); Meyer DM ( Department of Neurosciences, University of California, San Diego, California.); Hemmen TM ( Department of Neurosciences, University of California, San Diego, California.); Meyer BC ( Department of Neurosciences, University of California, San Diego, California.) |
| Abstract |
BACKGROUND: Rapid diagnosis in stroke is critical. Computed tomography is often performed initially, even before a neurologic examination. Gaze deviation has been correlated with stroke diagnosis in some cohorts. Conjugate gaze deviation on stroke code imaging, the 'DeyeCOM sign,' may have emergency stroke care implications. METHODS: We evaluated stroke code imaging from the University of California, San Diego database (2007-2013) for 'DeyeCOM sign' diagnostic and predictive utility. Patients were grouped as DeyeCOM+ if conjugate gaze deviation was noted. The differences were assessed using the Fisher exact test for categorical and the Wilcoxon rank-sum test for continuous variables. RESULTS: We evaluated 342 patients; 106 (31%) were DeyeCOM+. Mean age was 63. The most common diagnoses in the DeyeCOM+ group were ischemic stroke (50.94%), transient ischemic attack (8.49%), other (8.49%), somatization (6.6%), and hemorrhage (5.66%). The National Institutes of Health Stroke Scale was greater in stroke patients than that in nonstroke (8.2 versus 3.8; P < .0001), and in DeyeCOM+ compared with DeyeCOM- (6.8 versus 5.6; P = .03). DeyeCOM+ patients were more likely to have a +gaze score (26.4% versus 9.8%; P < .0001), and +gaze patients were more likely to have final stroke diagnosis (26.0% versus 3.6%; P < .0001). There was no overall difference between groups in final stroke diagnosis; however, patients with deviation of 15° or more were more likely to have final diagnosis stroke (63.9% versus 47.9%; P = .03). CONCLUSIONS: DeyeCOM+ patients scored higher and were more likely to have +gaze on the stroke scale, and deviation of 15° or more was correlated with final diagnosis stroke. In current environments, there is pressure to complete stroke evaluations rapidly. Reliable imaging information obtained early (such as gaze deviation on scan correlating with scale score and final stroke diagnosis) could augment decision making even with negative imaging. |
| File Format |
HTM / HTML |
| ISSN |
10523057 |
| e-ISSN |
15328511 |
| DOI |
10.1016/j.jstrokecerebrovasdis.2015.01.040 |
| Journal |
Journal of Stroke and Cerebrovascular Diseases |
| Issue Number |
6 |
| Volume Number |
24 |
| Language |
English |
| Publisher |
Elsevier |
| Publisher Date |
2015-06-01 |
| Publisher Place |
United States |
| Access Restriction |
Open |
| Subject Keyword |
Research Support, N.i.h., Extramural Brain Ischemia Stroke Eye Movements Ischemic Attack, Transient Predictive Value Of Tests Intracranial Hemorrhages Physiopathology Radiography Neurologic Examination Time Factors Discipline Cardiology Physiology Diagnosis |
| Content Type |
Text |
| Resource Type |
Article |
| Subject |
Neurology (clinical) Rehabilitation Cardiology and Cardiovascular Medicine Surgery |
