Microvascular retinal abnormalities in acute intracerebral haemorrhage and lacunar infarction

Gobron, C.; Erginay, Ali; Massin, Pascale; Lutz, Gabriel; Tessier, Nolwenn; Vicaut, Éric; Chabriat, Hugues

doi:10.1016/j.neurol.2013.07.029

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…Several studies have demonstrated that the presence of arteriolar narrowing and venular widening is associated with the incidence of stroke, 25,26 and the incidence of lacunar strokes 27,28 . Retinal hemorrhages were also associated with cerebral hemorrhages 29,30 . Furthermore, venular widening has also been observed to have links with incident dementia, 31 prevailing dementia, 32,33 and prevailing Alzheimer disease 34 independent of age, blood pressure, and traditional risk factors.…”

Section: Fundus Photographymentioning

confidence: 99%

“…27,28 Retinal hemorrhages were also associated with cerebral hemorrhages. 29,30 Furthermore, venular widening has also been observed to have links with incident dementia, 31 prevailing dementia, 32,33 and prevailing Alzheimer disease 34 independent of age, blood pressure, and traditional risk factors. Indeed, a recent review by Rim and coworkers 35 found that both qualitatively and quantitatively assessed parameters on fundus photography were consistently associated with clinical cerebrovascular disease, including clinical stroke, cerebral hemorrhage, and stroke mortality.…”

Section: Use Of Fundus Photographs For End-organ Disease Prognosticationmentioning

confidence: 99%

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The New Era of Retinal Imaging in Hypertensive Patients

Tan

Yao

et al. 2022

Asia-Pacific Journal of Ophthalmology

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Structural and functional alterations in the microcirculation by systemic hypertension can cause significant organ damage at the eye, heart, brain, and kidneys. As the retina is the only tissue in the body that allows direct imaging of small vessels, the relationship of hypertensive retinopathy signs with development of disease states in other organs have been extensively studied; large-scale epidemiological studies using fundus photography and advanced semi-automated analysis software have reported the association of retinopathy signs with hypertensive end-organ damage includes the following: stroke, dementia, and coronary heart disease. Although yielding much useful information, the vessels assessed from fundus photographs remain limited to the larger retinal arterioles and venules, and abnormalities observed may not be that of the earliest changes. Newer imaging modalities such as optical coherence tomography angiography and adaptive optics technology, which allow a greater precision in the structural quantification of retinal vessels, including capillaries, may facilitate the assessment and management of these patients. The advent of deep learning technology has also augmented the utility of fundus photographs to help create diagnostic and risk stratification systems. Particularly, deep learning systems have been shown in several large studies to be able to predict multiple cardiovascular risk factors, major adverse cardiovascular events within 5 years, and presence of coronary artery calcium, from fundus photographs alone. In the future, combining deep learning systems with the imaging precision offered by optical coherence tomography angiography and adaptive optics could pave way for systems that are able to predict adverse clinical outcomes even more accurately.

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Section: Fundus Photographymentioning

confidence: 99%

Section: Use Of Fundus Photographs For End-organ Disease Prognosticationmentioning

confidence: 99%

The New Era of Retinal Imaging in Hypertensive Patients

Tan

Yao

et al. 2022

Asia-Pacific Journal of Ophthalmology

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“…According to data from ARIC, CWS and other signs of hypertensive retinopathy confer a two-to fourfold increase in stroke risk over the ensuing 3 years after they are initially identified on exam [37]. Interestingly, cotton wool spots (along with retinal hemorrhages) may be more closely associated with intracerebral hemorrhagic strokes versus ischemic lacunar strokes than other stigmata of hypertensive retinopathy [38]. Furthermore, even after controlling for preexisting heart disease, hypertension, diabetes mellitus, and other cardiovascular risk factors, CWS (along with intraretinal hemorrhages and microaneurysms) are associated with a twofold higher risk of incident congestive heart failure diagnosis, and a threefold higher risk of acute events related to heart failure [39].…”

Section: Cotton Wool Spotsmentioning

confidence: 99%

Retinal Findings and Cardiovascular Risk: Prognostic Conditions, Novel Biomarkers, and Emerging Image Analysis Techniques

Colcombe,

Mundae,

Kaiser

et al. 2023

JPM

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Many retinal diseases and imaging findings have pathophysiologic underpinnings in the function of the cardiovascular system. Myriad retinal conditions, new imaging biomarkers, and novel image analysis techniques have been investigated for their association with future cardiovascular risk or utility in cardiovascular risk prognostication. An intensive literature search was performed to identify relevant articles indexed in PubMed, Scopus, and Google Scholar for a targeted narrative review. This review investigates the literature on specific retinal disease states, such as retinal arterial and venous occlusions and cotton wool spots, that portend significantly increased risk of future cardiovascular events, such as stroke or myocardial infarction, and the implications for personalized patient counseling. Furthermore, conditions diagnosed primarily through retinal bioimaging, such as paracentral acute middle maculopathy and the newly discovered entity known as a retinal ischemic perivascular lesion, may be associated with future incident cardiovascular morbidity and are also discussed. As ever-more-sophisticated imaging biomarkers and analysis techniques are developed, the review concludes with a focused analysis of optical coherence tomography and optical coherence tomography angiography biomarkers under investigation for potential value in prognostication and personalized therapy in cardiovascular disease.

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“…In addition to kidney disease, retinal disease may also be associated with CSVD, especially in patients with diabetes. Although there are conflicting results, one study of patients without diabetes who had either acute ICH or LS showed that both were associated with retinal disease . More investigation is needed to better understand these complex associations.…”

Section: Association With Systemic Small Vessel Diseasementioning

confidence: 99%

Advances in Understanding the Pathophysiology of Lacunar Stroke

et al. 2018

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troke is the second leading cause of death in the world and the leading cause of disability in the United States. 1 Among ischemic strokes, there are different subtypes, including large artery atherosclerosis, cardioembolism, and cerebral small vessel disease (CSVD). Although CSVD has several clinical and radiographic manifestations, lacunar stroke (LS) is prototypical and accounts for 20% to 30% of ischemic strokes. 2,3 Clinically, LS can manifest with several syndromes depending on lesion location. 4 Silent LSs are found in 20% to 50% of healthy elderly people. 5 Lacunar strokes are particularly burdensome, with a 20% recurrence rate, 25% fiveyear mortality, and associated morbidities, such as vascular cognitive impairment. 3 Lacunar strokes, appropriately named given their propensity to form cavities (lacunes), were first described in 1838 (Figure 1). 3 More recently, the Standards for Reporting Vascular Changes on Neuroimaging definitions were developed to standardize terms that describe the appearance of sequelae of CSVD, including recent small subcortical infarcts, lacunes, white matter hyperintensities (WMHs), perivascular spaces, microbleeds, and brain atrophy, on imaging. 6 Lacunar strokes primarily encompass 2 terms: recent small subcortical infarcts, defined as recent infarctions in the territory of 1 perforating arteriole with imaging features or clinical symptoms consistent with occurrence in the previous few weeks, and lacunes, defined as round or ovoid, subcortical, fluid-filled cavities 3 to 15 mm in diameter, consistent with previous acute small subcortical infarcts or hemorrhages in the territory of 1 perforating arteriole. 6 Although this review focuses on LS, other abnormalities that result from CSVD are relevant because there are interrelated mechanisms and treatment implications. For example, recent small subcortical infarcts can also contribute to WMH, 3 and many intracerebral hemorrhages (ICHs) likely result from similar vessel abnormalities. 7 This suggests that patients with LS may have an increased risk for bleeding when taking antithrombotic medications. IMPORTANCE Stroke is the second leading cause of death in the world, and nearly one-third of ischemic strokes are lacunar strokes (LSs) or small subcortical infarcts. Although smaller in size, they create large problems, leaving many patients with intellectual and physical disabilities. Because there are limitations in understanding the underlying pathophysiology of LS, the development of novel therapies has been slow.OBSERVATIONS When the term lacune was described in the 1800s, its underlying pathophysiological basis was obscure. In the 1960s, C. Miller Fisher, MD, performed autopsy studies that showed that vessels supplying lacunes displayed segmental arteriolar disorganization, characterized by vessel enlargement, hemorrhage, and fibrinoid deposition. For these pathologic changes, he coined the term lipohyalinosis. Since that time, few attempts have been made to reconcile this pathologic description with modern mechanisms of cerebr...

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Microvascular retinal abnormalities in acute intracerebral haemorrhage and lacunar infarction

Cited by 6 publications

References 18 publications

The New Era of Retinal Imaging in Hypertensive Patients

The New Era of Retinal Imaging in Hypertensive Patients

Retinal Findings and Cardiovascular Risk: Prognostic Conditions, Novel Biomarkers, and Emerging Image Analysis Techniques

Advances in Understanding the Pathophysiology of Lacunar Stroke

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