Purchase this article with an account.
Praneetha Thulasi, Laurel Vuong, Valerie Biousse, David Wright, Nancy J Newman, Beau B Bruce; Nonmydriatic Ocular Fundus Photography among Patients with Focal Neurologic Deficits in an Emergency Department (ED). Invest. Ophthalmol. Vis. Sci. 2014;55(13):5113.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
While several large cohort studies have associated ocular fundus abnormalities with the long-term risk of stroke, the value of ocular fundus examination in patients presenting with focal neurologic deficits, particularly suspected transient ischemic attack (TIA) and stroke, has not been evaluated. The ABCD2 score is widely used for the risk stratification of patients with suspected TIA, but does not include fundus findings. Our objective was to determine the frequency of and the predictive factors for abnormal ocular fundus findings among ED patients who presented with focal neurologic deficits.
Cross-sectional study of prospectively enrolled adult patients presenting to our ED with a chief complaint of focal neurological deficits. Ocular fundus photographs were obtained using a non-mydriatic fundus camera. Demographic and neuro-imaging information were collected, including the ABCD2 score components. Two neuro-ophthalmologists independently reviewed photographs for acute retinopathic/vasculopathic findings (i.e., retinal hemorrhages, cotton wool spots, grade III/IV hypertensive retinopathy, and retinal vascular occlusions). The results were analyzed using univariate statistics and logistic regression modeling.
We included 257 patients (median age: 52 years, 63% women), among whom 81 (32%) had cerebrovascular disease (CVD; 22 strokes, 59 TIAs) and 17 (7%; 95%CI:4-11%) had acute retinopathic/vasculopathic findings. Acute retinopathic/vasculopathic findings were associated with CVD among patients with focal neurologic deficits (odds ratio [OR]=3.4; 95%CI:1.2-9.3; p=0.02), and a trend toward association remained after controlling for ABCD2 score and abnormal diffusion weighted imaging (DWI; OR=2.5; 95%CI=0.8-7.2; p=0.10).
Ocular fundus abnormalities were found in 7% of patients presenting with focal neurologic defects to our ED, and predicted CVD among these patients, probably even after accounting for ABCD2 score and DWI lesions. This suggests that inclusion of non-mydriatic ocular fundus photographs in the evaluation of patients with focal neurologic deficits could assist in the differentiation of high-risk CVD from other causes of focal neurologic deficits and warrants additional study.
This PDF is available to Subscribers Only