Eye signs for the neurologist in the Intensive Care Unit.

INTRODUCTION: The eyes are a window to the brain' is a maxim that holds true especially in the intensive care setting. Recognising specific eye signs aids rapid decision-making regarding diagnosis or prognosis. Eye signs play a pivotal role in intensive care for the neurologist. STATE OF THE ART: Eye signs have long been considered the best clinical clue for assessment of a comatose patient. In critically ill patients, the recognition of brainstem involvement hinges primarily on eye signs. The ability to recognise and interpret these signs goes a long way towards ensuring proper care of neurological illness in intensive care units. CLINICAL IMPLICATIONS: In this article we enumerate the various signs to be assessed in the ocular and periocular structures. We look at the various types of nystagmus and abnormal eye movements which help to localise lesions in the brainstem. This will aid better diagnosis and prognostication. We categorise eye signs as Category 1 or 2 according to whether they are periorbital and ocular signs or oculomotor abnormalities. Category 2 signs are further sub-classified into Category 2a - common and Category 2b - uncommon. FUTURE DIRECTIONS: Clinical anatomical correlation of specific signs such as ocular dipping has yet to be elucidated. Research that looks into specific eye signs may help with better anatomic correlation and localisation of lesions.

Fast micrographia: An unusual but distinctive sign.

Fast micrographia is a rare clinical sign, which is reported in patients with pallidal pathology. A 68-year-old male presented with hypophonia and short shuffling gait with decreased arm swing. About 3 weeks before, he had an acute myocardial infarction and a period of hemodynamic and respiratory distress during which he required mechanical ventilatory support. He was found to have a fast handwriting with micrographia from the outset. His rapid alternating hand and finger movements were normal. Magnetic resonance imaging (MRI) of the brain showed features of hypoxic ischemic encephalopathy including hyperintensities on T1 and T2 weighted images in the globus pallidus, and putamen bilaterally.