[Retinal microangiopathy in arterial hypertension as an early marker of a cerebral macroangiopathy]

Dtsch Med Wochenschr. 2011 Nov;136(46):2355-8. doi: 10.1055/s-0031-1292050. Epub 2011 Nov 8.
[Article in German]


History and admission findings: A 54-year-old man reported having had nonspecific attacks of dizziness. His BMI was 27.7. Since 11 years he had been treated for arterial hypertension and had received oral medication for type 2 diabetes for one year. The latest blood pressure value was 134/109 mm Hg during treatment with a combination of atenolol, chlortalidone und hydralazine-HCl; furthermore hr received simvastatin, metformin, glimepirid und ramipril. A standardized telemedical imaging of the retina ("talkingeyes (®) ") was undertaken, revealing focal and generalized arteriolar narrowing of the retinal vessels and a retinal microinfarction (cotton wool spot) in the right eye. The arterial/venous ratio was decreased to 0.74 in the right and 0.77 in the left eye.

Investigations: Optical coherence tomographie (OCT) revealed an ischemic microinfarction of the retina with marked axonal swelling. The digital subtraction angiography of the cerebral vessels revealed a 40 % stenosis of the right internal carotid artery and a proximal, highgrade stenosis of the basilary artery.

Treatment and course: Angioplasty with stent insertion of the basilary artery was performed. Long-term observation showed no restenosis and a reduction in the size of the the retinal microinfarct.

Conclusion: Retinal microinfarctions denote localized retinal areas of hypoxia and underperfusion. They may act as markers of a generalized micro- and macroangiopathy. Patients with severe retinal microangiopathic changes should be examined thoroughly to detect early macroangiopathic changes. These can be treated by interventional procedures thus avoiding irreversible end-organ damages.

Publication types

  • Case Reports
  • English Abstract
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angioplasty
  • Carotid Stenosis / complications
  • Carotid Stenosis / diagnosis
  • Carotid Stenosis / pathology
  • Carotid Stenosis / surgery
  • Cerebrovascular Disorders / complications*
  • Cerebrovascular Disorders / diagnosis*
  • Cerebrovascular Disorders / pathology
  • Cerebrovascular Disorders / surgery
  • Humans
  • Male
  • Middle Aged
  • Retinal Diseases / complications*
  • Retinal Diseases / diagnosis*
  • Retinal Diseases / pathology
  • Retinal Vessels / pathology*
  • Tomography, Optical Coherence
  • Treatment Outcome