Aim. To evaluate the profile of ocular gaze abnormalities occurring following stroke. Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol including assessment of visual acuity, ocular alignment and motility, visual field, and visual perception. Results. 915 patients recruited: mean age 69.18 years (SD 14.19). 498 patients (54%) were diagnosed with ocular motility abnormalities. 207 patients had gaze abnormalities including impaired gaze holding (46), complete gaze palsy (23), horizontal gaze palsy (16), vertical gaze palsy (17), Parinaud’s syndrome (8), INO (20), one and half syndrome (3), saccadic palsy (28), and smooth pursuit palsy (46). These were isolated impairments in 50% of cases and in association with other ocular abnormalities in 50% including impaired convergence, nystagmus, and lid or pupil abnormalities. Areas of brain stroke were frequently the cerebellum, brainstem, and diencephalic areas. Strokes causing gaze dysfunction also involved cortical areas including occipital, parietal, and temporal lobes. Symptoms of diplopia and blurred vision were present in 35%. 37 patients were discharged, 29 referred, and 141 offered review appointments. 107 reviewed patients showed full recovery (4%), partial improvement (66%), and static gaze dysfunction (30%). Conclusions. Gaze dysfunction is common following stroke. Approximately one-third of patients complain of visual symptoms, two thirds show some improvement in ocular motility. 1. Introduction Ocular motility (eye movement) problems are reported commonly following stroke in up to 68% of cases [1–5]. These problems can include cranial nerve palsy [6], vergence and accommodative dysfunction [3], strabismus [2, 7], and nystagmus [8]. Such eye movement abnormalities can cause symptoms of diplopia, blurred vision, compensatory head posture, nausea, and dizziness because of the inability to move one or both eyes into a particular gaze direction [1, 9, 10]. These symptoms can impact on activities of daily living and quality of life by impairing reading ability and hindering mobility because of instability [11]. Gaze abnormalities may include horizontal and/or vertical conjugate gaze palsy, internuclear ophthalmoplegia (INO), one and a half syndrome, and saccadic and smooth pursuit palsy [12]. Much of the medical literature describing these gaze abnormalities is in the form of case reports and small case series of individual types of gaze abnormality [13–17]. However, there are few large scale studies documenting these problems in stroke populations. We sought
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