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. 2018 Jun;27(6):1466-1470.
doi: 10.1016/j.jstrokecerebrovasdis.2017.12.035. Epub 2018 Feb 15.

The Sustained DeyeCOM Sign as a Predictor of Large Vessel Occlusions and Stroke Mimics

Kevin S Attenhofer  1 , Lovella Hailey  2 , Melissa Mortin  2 , Karen S Rapp  2 , Kunal Agrawal  2 , Branko Huisa-Garate  2 , Royya Modir  2 , Dawn M Meyer  2 , Thomas M Hemmen  2 , Brett C Meyer  2
Affiliations

The Sustained DeyeCOM Sign as a Predictor of Large Vessel Occlusions and Stroke Mimics

Kevin S Attenhofer et al. J Stroke Cerebrovasc Dis. 2018 Jun.

Abstract

Introduction: Rapid imaging in acute stroke is critical and often occurs before full examination. Early, reliable examination findings clarify diagnosis and improve treatment times. The DeyeCOM sign has been described as a predictor of ischemic stroke. In this study, we evaluate a sustained DeyeCOM sign on serial computed tomography scans in prediction of large vessel occlusion.

Methods: Between April and June 2017, we retrospectively reviewed 46 patients with acute stroke from the University of California, San Diego Stroke Registry, who had both computed tomography and computed tomography angiography as part of their acute work-up. A DeyeCOM(+) sign was defined as a conjugate gaze deviation on imaging of at least 15°. DeyeCOM(++) was defined as sustained gaze deviation on both scans.

Results: Three groups of patients were observed: DeyeCOM(++), nonsustained gaze deviation, and no gaze deviation (DeyeCOM(--)). All patients in the DeyeCOM(++) (8 of 8, 100%) had large vessel occlusion. Of those with nonsustained gaze deviation, 2 of 7 (29%) had large vessel occlusion. No patients in the DeyeCOM(--) (0 of 31, 100%) had large vessel occlusion. The specificity and sensitivity of DeyeCOM(++) for large vessel occlusion was 100% (confidence interval [CI] .90-1.0) and 80% (CI .44-.97). The specificity and sensitivity of DeyeCOM(--) for absence of large vessel occlusion was 100% (CI .69-1.0) and 86% (CI .70-.95).

Conclusions: DeyeCOM(++) had 100% specificity for large vessel occlusion, whereas DeyeCOM(--) had a 100% specificity for absence of large vessel occlusion. Sustained DeyeCOM, whether positive or negative, is a strong predictor of ultimate diagnosis that could lead to quicker endovascular treatment times.

Keywords: CT; CTA; acute ischemic stroke; large vessel occlusion; neuroradiology.

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Figures

Figure 1
Figure 1
Non-contrast axial CT scan with calipers creating two angles, one for each eye. Right eye is deviated 18.1 degrees from midline. The left eye is deviated 16.3 degrees.
Figure 2
Figure 2
Algorithm for cohort classification.
See this image and copyright information in PMC

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