Co-occurrence of Acute Retinal Artery Occlusion and Acute Ischemic Stroke: Diffusion-Weighted Magnetic Resonance Imaging Study

Am J Ophthalmol. 2014 Jun;157(6):1231-8. doi: 10.1016/j.ajo.2014.01.033. Epub 2014 Feb 4.

Abstract

Purpose: To evaluate the co-occurrence of acute ischemic stroke and acute retinal artery occlusion (RAO).

Design: Retrospective observational case series.

Methods: We included 33 consecutive patients with acute RAO who underwent diffusion-weighted magnetic resonance imaging within 7 days of the onset of visual symptoms. The causes of RAO were classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria, which are based on clinical features and the results of etiological evaluations for atherosclerosis, cardioembolism and other prothrombotic conditions. We evaluated the prevalence of accompanying acute ischemic stroke in subjects with acute RAO and examined the relationships with etiological parameters.

Results: Acute ischemic stroke was detected in 8 (24.2%) subjects with RAO. Among these subjects, 3 (37.5%) patients did not exhibit any neurologic symptoms or signs. Most of the infarction patterns were small, multiple and scattered. All of the subjects with RAO who were positive for lesions on diffusion-weighted imaging had identifiable causes, whereas only 36% of the subjects who were negative for lesions had identifiable etiologies (P = .003). Carotid stenosis or cardioembolic sources were found more commonly in cases of central retinal artery occlusion (CRAO; 7/18, 38.9%) than in cases of branch retinal artery occlusion (BRAO; 1/15 6.7%, P = .046).

Conclusions: Acute cerebral infarctions frequently accompany RAO. We recommend diffusion-weighted imaging for patients with RAO because the presence of lesions on diffusion-weighted imaging is accompanied by a significantly increased probability of identifying the cause.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Cerebral Infarction / complications*
  • Cerebral Infarction / diagnosis
  • Diffusion Magnetic Resonance Imaging*
  • Echocardiography, Transesophageal
  • Electrocardiography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Retinal Artery Occlusion / complications*
  • Retinal Artery Occlusion / diagnosis
  • Retrospective Studies
  • Visual Acuity
  • Young Adult