Three patients with spontaneous supratentorial intracerebral hemorrhage had contralateral sustained conjugate gaze deviation. The autopsies disclosed large thalamic-basal ganglia hemorrhages whose caudal extension was limited to the midbrain. Current knowledge of oculomotor localization does not adequately explain this "wrong-side" gaze deviation, and the mechanism remains obscure. The present cases suggest that thalamic hemorrhage can produce contralateral gaze deviation without involving postdecussation horizontal oculomotor pathways. Contralateral gaze deviation is not a rare occurrence with deep supratentorial hemorrhages, and awareness of this confusing sign should assist in localizing intracerebral hematomas.
Keane JR. Contralateral Gaze Deviation With Supratentorial Hemorrhage: Three Pathologically Verified Cases. Arch Neurol. 1975;32(2):119–122. doi:10.1001/archneur.1975.00490440069011
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