Eye tracking detects disconjugate eye movements associated with structural traumatic brain injury and concussion

Uzma Samadani, Robert Ritlop, Marleen Reyes, Elena Nehrbass, Meng Li, Elizabeth Lamm, Julia Schneider, David Shimunov, Maria Sava, Radek Kolecki, Paige Burris, Lindsey Altomare, Talha Mehmood, Theodore Smith, Jason H Huang, Christopher McStay, S Rob Todd, Meng Qian, Douglas Kondziolka, Stephen Wall, Paul Huang, Uzma Samadani, Robert Ritlop, Marleen Reyes, Elena Nehrbass, Meng Li, Elizabeth Lamm, Julia Schneider, David Shimunov, Maria Sava, Radek Kolecki, Paige Burris, Lindsey Altomare, Talha Mehmood, Theodore Smith, Jason H Huang, Christopher McStay, S Rob Todd, Meng Qian, Douglas Kondziolka, Stephen Wall, Paul Huang

Abstract

Disconjugate eye movements have been associated with traumatic brain injury since ancient times. Ocular motility dysfunction may be present in up to 90% of patients with concussion or blast injury. We developed an algorithm for eye tracking in which the Cartesian coordinates of the right and left pupils are tracked over 200 sec and compared to each other as a subject watches a short film clip moving inside an aperture on a computer screen. We prospectively eye tracked 64 normal healthy noninjured control subjects and compared findings to 75 trauma subjects with either a positive head computed tomography (CT) scan (n=13), negative head CT (n=39), or nonhead injury (n=23) to determine whether eye tracking would reveal the disconjugate gaze associated with both structural brain injury and concussion. Tracking metrics were then correlated to the clinical concussion measure Sport Concussion Assessment Tool 3 (SCAT3) in trauma patients. Five out of five measures of horizontal disconjugacy were increased in positive and negative head CT patients relative to noninjured control subjects. Only one of five vertical disconjugacy measures was significantly increased in brain-injured patients relative to controls. Linear regression analysis of all 75 trauma patients demonstrated that three metrics for horizontal disconjugacy negatively correlated with SCAT3 symptom severity score and positively correlated with total Standardized Assessment of Concussion score. Abnormal eye-tracking metrics improved over time toward baseline in brain-injured subjects observed in follow-up. Eye tracking may help quantify the severity of ocular motility disruption associated with concussion and structural brain injury.

Keywords: concussion; cranial nerve palsy; disconjugate; eye movement tracking; ocular motility.

Figures

FIG. 1.
FIG. 1.
Relative distribution of trauma patients and noninjured controls (y-axis) versus disconjugacy (x-axis) to demonstrate that control subjects have the greatest proportion of patients with low horizontal disconjugacy and positive CT patients have the highest proportion of patients with high horizontal disconjugacy as the eyes move along the bottom segment of the box trajectory. Negative CT patients have a disconjugacy in between positive CT and non-head-injured control subjects. Kruskal-Wallis' statistical analysis yielded a value of p<0.05 for CT+ and CT− relative to noninjured controls. CT, computed tomography. Color image available online at www.liebertpub.com/neu
FIG. 2.
FIG. 2.
Left segment of the box trajectory was disconjugate in the horizontal plane in positive and negative CT brain-injured subjects, but not in non-head-injured subjects relative to noninjured controls. Kruskal-Wallis' statistical analysis yielded a value of p<0.05 for CT+ and CT− relative to noninjured controls. CT, computed tomography. Color image available online at www.liebertpub.com/neu
FIG. 3.
FIG. 3.
Bottom segment of the box trajectory's horizontal disconjugacy in nonstructural brain injury improved over time, yet remained statistically significantly different even at 4 weeks postinjury. CT, computed tomography. Color image available online at www.liebertpub.com/neu
FIG. 4.
FIG. 4.
Left segment of the box trajectory's horizontal disconjugacy in nonstructural brain injury improved over time, and by 4 weeks postinjury, was equal to normal controls. CT, computed tomography. Color image available online at www.liebertpub.com/neu

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