Citation, DOI, disclosures and article data
Citation:
Gaillard F, Sharma R, Weerakkody Y, et al. Prévost sign (eyes). Reference article, Radiopaedia.org (Accessed on 06 Oct 2024) https://doi.org/10.53347/rID-5606
The Prévost sign, also known as the Vulpian sign or eye sign, refers to conjugate eye deviation in patients with acute stroke. The direction is variable, depending on the location of the stroke 3.
In a hemispheric stroke, the eyes deviate ipsilaterally towards the stroke (i.e. contralateral to the hemiparesis), due to involvement of the frontal eye fields. The degree of deviation may be exaggerated when the head is turned in the same direction. Eye deviation is most pronounced with non-dominant hemisphere (usually, right hemisphere) strokes, presumably due to concurrent presence of neglect/extinction 2,3,6.
Involvement of the thalamus, on the other hand, usually results in conjugate gaze deviation away from the lesion and thus towards the side of hemiparesis 3. This is sometimes known as "wrong-way eyes" 5.
History and etymology
It is named after Jean Louis Prévost, Swiss physician (1838-1927) and Edme Felix Alfred Vulpian (1826 -1887) 4.
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1. Fruhmann Berger M, Pross RD, Ilg U, Karnath HO. Deviation of eyes and head in acute cerebral stroke. BMC neurology. 6: 23. doi:10.1186/1471-2377-6-23 - Pubmed
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2. Derakhshan I. How do the eyes move together? New understandings help explain eye deviations in patients with stroke. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 172 (2): 171-3. doi:10.1503/cmaj.1040322 - Pubmed
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3. Shoichiro Sato, Masatoshi Koga, Hiroshi Yamagami, Satoshi Okuda, Yasushi Okada, Kazumi Kimura, Yoshiaki Shiokawa, Jyoji Nakagawara, Eisuke Furui, Yasuhiro Hasegawa, Kazuomi Kario, Shoji Arihiro, Kazuyuki Nagatsuka, Kazuo Minematsu, Kazunori Toyoda. Conjugate Eye Deviation in Acute Intracerebral Hemorrhage. Stroke. 43 (11): 2898. doi:10.1161/STROKEAHA.112.666750 - Pubmed
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4. John M S Pearce. Fragments of Neurological History. ISBN: 9781783261109
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5. Friedman Y, Pettersen J, Aviv R, Murray B. Neurological Picture. The "Eye Sign" in Acute Stroke: Not Necessarily Poor Outcome. J Neurol Neurosurg Psychiatry. 2009;80(3):291. doi:10.1136/jnnp.2008.160382 - Pubmed
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6. Porto F, Machado G, da Silva M, de Freitas G. The "Eye Sign" Due to Hemispatial Neglect: A Case Report. Dement Neuropsychol. 2009;3(3):256-9. doi:10.1590/S1980-57642009DN30300013 - Pubmed
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