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Lucy Zhang, Richard Kim, Danielle Rudich, Robert Lesser, David Greer, Hardik Amin; Acute ischemic stroke in monocular vision loss of vascular etiology. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5558.
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To evaluate the rate of co-occurrence of acute ischemic stroke and monocular vision loss of vascular etiology, as diagnosed by magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI). Two recent retrospective studies have shown that patients with monocular vision loss of ischemic origin are also more likely to have acute brain infarcts; however, these studies did not exclude patients with concurrent focal neurologic deficits (totaling 13-15% of their study populations). The goal of our study is to evaluate the likelihood of subclinical acute stroke identified on DWI in patients presenting with isolated monocular vision loss.
A retrospective analysis was performed using medical records from February 2013 through August 2014 at Yale-New Haven Hospital of patients who were diagnosed with monocular vision loss. Patients whose vision loss was likely related to a vascular etiology (such as amaurosis fugax or central or branch retinal vascular occlusion) and who underwent brain MRI within a seven day period were included. We determined the proportion of patients with monocular vision loss and acute stroke on brain MRI.
A total of 448 records were reviewed. Of these, 293 patients had monocular vision loss of suspected or confirmed vascular etiology. Seventy-four patients were excluded due to the presence of other focal neurologic symptoms. Of the remaining 219 patients, 54 underwent MRI of the brain within seven days of the onset of symptoms, and 13 (24%) were found to have evidence of acute ischemic stroke based on restricted diffusion.
Patients with monocular vision loss due to amaurosis fugax, CRAO, or BRAO may have up to 24% risk of ischemic stroke as a result of thromboembolic phenomena. This study provides further evidence that ophthalmologists should refer monocular vision loss patients for neurologic evaluation and brain MRI with DWI even when vision loss is the isolated symptom.
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