Retinal strokes. I. Incidence of carotid atheromata

Kollarits, Carol R.

doi:10.1001/jama.222.10.1273

Cited by 56 publications

(21 citation statements)

References 6 publications

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“…Nevertheless, our findings support the Retinal ischemia is associated with ICA disease. [5][6][7] In this study a high-grade ICA stenosis of 70% or more, or occlusion, was detected in 73% of cases with retinal ischemia. The frequency of cerebral microembolism correlated significantly with the severity of ICA stenosis, suggesting that the source of the microemboli was often the ipsilateral carotid artery.…”

Section: Discussionmentioning

confidence: 83%

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Cerebral Microembolism in Patients With Retinal Ischemia

Wijman

Babikian

Matjucha

et al. 1998

Stroke

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Background and Purpose-We investigated the frequency of cerebral microembolism detected by transcranial Doppler ultrasonography in patients with clinical evidence of retinal ischemia, including transient monocular blindness, central and branch retinal artery infarction, and ischemic oculopathy, and assessed its correlation with carotid artery stenosis. Methods-Records of 331 consecutive patients examined during a 47-month period at the Neurovascular Laboratory were reviewed. Of the original 453 intracranial arteries, 186 middle cerebral arteries (MCAs) satisfied qualifying criteria that excluded patients with cardiac embolic sources. Forty-five MCAs ipsilateral to the symptomatic eye constituted the study group. The control group consisted of 141 asymptomatic MCAs. Microembolus detection studies were performed on transcranial Doppler instruments equipped with special software, and the degree of carotid artery stenosis was measured by cerebral or MR angiography or by color duplex studies. Results-Microembolism was detected in 40.0% of study MCAs and 9.2% of controls (PϽ0.001). In the study group, microembolic signals were detected in 61.9% of MCAs tested within a week of symptom onset and 20.8% of those tested afterward (PϽ0.001). Severe (Ն70%) carotid stenosis or occlusion was more frequent in the study group (PϽ0.001). Microembolic signals were detected in 25.3% and 11.2%, respectively, of MCAs distal to carotid arteries with 70% to 100% and 0% to 69% stenosis (Pϭ0.013). Conclusions-In patients without cardiac embolic sources, cerebral microembolism is frequently present on the side of retinal ischemia, particularly during the week after onset of symptoms. It is often associated with severe stenosis or occlusion of the ipsilateral carotid artery.

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Section: Discussionmentioning

confidence: 83%

“…[5][6][7] Common mechanisms of TMB are embolism, causing transient occlusion of retinal arterioles, and retinal vascular insufficiency secondary to a hemodynamically significant stenosis of feeding arteries. 8 Other less common etiologies include vasospasm, states of altered coagulability, and thrombocytosis.…”

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confidence: 99%

Cerebral Microembolism in Patients With Retinal Ischemia

Wijman

Babikian

Matjucha

et al. 1998

Stroke

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“…Both are ophthalmic emergencies and analogous to an acute stroke of the eye. Retinal ischemia has been documented in both adults and children following ocular trauma [32] , and also embolic [33] and vasospastic episodes [34] . With respect to spine surgery, these conditions are mostly commonly seen during the perioperative period from improper patient positioning and external compression on the eye [35] .…”

Section: Retinal Ischemia: Branch and Central Retinal Artery Occlusionmentioning

confidence: 99%

Perioperative visual loss after spine surgery

Nickels¹,

Manlapaz²,

Farag³

2014

WJO

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Perioperative visual loss (POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. According to the American Society of Anesthesiologists Postoperative Visual Loss Registry, the most common causes of POVL in spine procedures are the two different forms of ischemic optic neuropathy: anterior ischemic optic neuropathy and posterior ischemic optic neuropathy, accounting for 89% of the cases. Retinal ischemia, cortical blindness, and posterior reversible encephalopathy are also observed, but in a small minority of cases. A recent multicenter case control study has identified risk factors associated with ischemic optic neuropathy for patients undergoing prone spinal fusion surgery. These include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. These risk factors are thought to contribute to the elevation of venous pressure and interstitial edema, resulting in damage to the optic nerve by compression of the vessels that feed the optic nerve, venous infarction or direct mechanical compression. This review will expand on these findings as well as the recently updated American Society of Anesthesiologists practice advisory on POVL. There are no effective treatment options for POVL and the diagnosis is often irreversible, so efforts must focus on prevention and risk factor modification. The role of crystalloids versus colloids and the use of α-2 agonists to decrease intraocular pressure during prone spine surgery will also be discussed as a potential preventative strategy. Core tip: Perioperative visual loss (POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. Ischemic optic neuropathy accounts for the vast majority of these cases, with retinal ischemia, cortical blindness, and posterior reversible encephalopathy observed with low incidence. Recently identified risk factors include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. POVL is often permanent and untreatable, so prevention is key to limiting its impact. Nickels TJ, Manlapaz MR, Farag E. Perioperative visual loss after spine surgery. World J Orthop 2014; 5(2): 100-106 Available from:

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“…Artery occlusion occurs primarily in the elderly, with clinical findings suggestive of atheromatous emboli 1 . It is an extremely rare diagnosis in the pediatric population and the etiology with risk factors of retinal artery occlusion are poorly understood in younger individuals 2 .…”

Section: Introductionmentioning

confidence: 99%

Transient branch retinal artery occlusion in a 15-year-old girl and review of the literature

Stepanov¹,

Hejsek²,

Jirásková³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Retinal artery occlusion is an extremely rare diagnosis in the pediatric population and the etiology with risk factors of retinal artery occlusion are poorly understood in younger individuals. Methods and Results. This case report a rare case of transient branch retinal artery occlusion (BRAO) in a healthy young girl. A fifteen-year-old girl presented with painless decreased vision in her right eye. Fundus examination revealed in the right eye intensive edema of the part of superior half of the retina, but the vessels were absolutely normal. She was hospitalized for diagnosis and treatment. A thorough workup was performed to determine any etiologic factor. Her physical examination was normal, but from anamnesis has been found that patient began use oral contraception at the time of occurrence eye problems. The condition is evaluated as transient branch retinal artery occlusion by the course of the disease. The paper includes the review of the literature also. Conclusion. Though retinal arterial obstruction is rare in the pediatric population, this case highlights the importance of including this in the differential diagnosis of acute vision loss.

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Retinal strokes. I. Incidence of carotid atheromata

Cited by 56 publications

References 6 publications

Cerebral Microembolism in Patients With Retinal Ischemia

Cerebral Microembolism in Patients With Retinal Ischemia

Perioperative visual loss after spine surgery

Transient branch retinal artery occlusion in a 15-year-old girl and review of the literature

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