A study of ocular movements and pupillary changes in acute stroke patients

Background: Cerebrovascular disease or stroke rank first in frequency and importance, among all the neurological diseases of adult life. It is the third most common cause of death in the world. Different neuroanatomical pathways are involved in the control of pupil, the integrity and the functionality of these neurological pathways can be often be ascertained through the analysis and interpretation of pupillary behavior. This makes the pupil size and the pupillary light reflex an important factor to be considered in many clinical conditions. Aim and objective: To study the ocular movements and pupils in acute stroke patients with its clinical correlation and imaging. Materials and methods: The study sample included was 50 patients with acute stroke confirmed by CT/MRI findings of both sexes and who belonged to the age group of 20 to 80 years from RMMCH. A detailed clinical history was taken for these patients who were included in this study. All these patients were examined thoroughly with particular importance to ocular movements and pupils. Results: Of the 50 patients, 16 patients were having an altered level of consciousness(32%), 30 patients were having speech disturbances(72%), 18 patients were having gaze paresis(36%), all the patients who were included in the study were having facial palsy (100%), Of the 18 patients with abnormal pupillary findings, there were 9 patients (18%) with dilated pupils which were not reacting to light during the first 12 hours, i.e. from the time of admission, 9 patients (18%) with round, constricted pupils, sluggishly reacting to light and 32 patients (64%) did not show any changes in the pupils. Of the 20 patients (40%) with abnormal ocular movements, the commonly observed ocular changes in the study sample were 3rd nerve palsy, 6th nerve palsy, multiple cranial nerve palsies, conjugate eye deviation to the side of the lesion, nystagmus on left lateral gaze, horizontal nystagmus on lateral gaze to the side of lesion. Conclusion: The Anterior circulation stroke (78%) was more common than the Posterior circulation stroke (22%) in our study group. Although the abnormal pupillary changes and ocular movements were very common in posterior cerebral artery territory infarcts, the incidence of abnormal pupillary changes and ocular movements was more common in posterior cerebral artery territory (50%) and also in middle cerebral artery territory (45%) in our study group.