What is the Best Gaze test designed to test?

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Best Gaze Assessment in the NIH Stroke Scale

The Best Gaze test (item 2) in the NIH Stroke Scale is specifically designed to test horizontal eye movement only. 1

Understanding the Best Gaze Test

The Best Gaze test evaluates horizontal eye movements through:

  • Voluntary horizontal eye movements
  • Reflexive movements (using oculocephalic reflex/Doll's eyes maneuver)
  • Only horizontal gaze is assessed, not vertical movements

According to the NIH Stroke Scale, the scoring for Best Gaze is:

  • 0 = Normal
  • 1 = Partial gaze palsy
  • 2 = Forced eye deviation or total paresis that cannot be overcome by Doll's eyes maneuver 1

Clinical Significance

The Best Gaze assessment is critical for:

  1. Detecting brainstem or cortical lesions: Abnormal horizontal gaze can indicate damage to:

    • Frontal eye fields
    • Pontine gaze centers
    • Cranial nerve VI (abducens) nuclei

  2. Stroke localization: Gaze abnormalities help localize stroke lesions:

    • Ipsilateral frontal lobe lesions may cause contralateral gaze deviation
    • Pontine lesions may cause ipsilateral gaze deviation

Differentiation from Other Tests

It's important to understand how Best Gaze differs from other neurological assessments:

  • Visual Field Testing (item 3): Assesses peripheral vision and tests for hemianopia or quadrantanopia 1
  • Extinction/Inattention (item 11): Evaluates neglect phenomena 1

Proper Technique

When performing the Best Gaze test:

  1. Ask the patient to follow your finger or a target horizontally
  2. If voluntary movement is impaired, use oculocephalic maneuver (Doll's eyes)
  3. Evaluate for symmetry, range, and smoothness of horizontal movements
  4. Do not test vertical eye movements as part of this assessment

Common Pitfalls

  • Confusing with visual field testing: Best Gaze specifically tests eye movement capability, not the visual field
  • Failing to use Doll's eyes maneuver: In patients with reduced consciousness, reflexive eye movements should be tested
  • Misinterpreting eye deviation: Acute eye deviation may be a localizing sign in stroke and should be carefully documented

Best Gaze assessment provides critical information about brainstem integrity and helps localize neurological lesions, making it an essential component of the NIH Stroke Scale for evaluating patients with suspected stroke.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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