Ophthalmological Symptoms, Signs and Outcome in Children with Arterial Stroke or Venous Thrombosis

Abstract

 

Purpose

 

To evaluate the role of the ophthalmologist at presentation and during follow-up of children with arterial stroke or venous thrombosis.

 

Methods

 

Design: A retrospective case-series design. Patients and Methods: The database of an ophthalmology service in a tertiary pediatric medical center was searched for all patients who were diagnosed with arterial stroke or venous thrombosis in 2005-2013 and followed for at least 2 months. Demographic data and findings on ophthalmological and neurological examination and neuroimaging were derived from the medical files.

 

Results

 

Thirty-two children met the inclusion criteria. Fourteen (44%) had arterial stroke, mainly in the middle cerebral artery. Ophthalmological manifestations included a visual acuity deficit in1 patient (7%) and a hemianopic visual field defect in 4 (29%). Eleven patients had a non-ophthalmological neurological deficit. At the last visit, 1 patient (7%) had no light perception, 4 (29%) a residual field deficit, and 5 (36%) a neurological deficit. Eighteen patients (56%) had venous strokes, mostly due to sigmoid sinus thrombosis associated with otitis media/mastoiditis. Ophthalmological manifestations included diplopia in 8 patients (44%), papilledema in 7 (39%), and reduced vision in 2 (11%). At the last visit, 2 had residual esotropia and 1 had a neurological deficit.

 

Conclusions

 

Arterial stroke has different ophthalmological manifestations from venous thrombosis in children. In venous stroke, the ophthalmologist plays an important role in the early diagnosis of papilledema and new-onset strabismus; in arterial stroke, the ophthalmologist localizes visual field defects and conducts rehabilitative follow-up. Both types of stroke have a generally good ophthalmological prognosis.

 

 

Figure 1: Acute right basal ganglia infarct - magnetic resonance (MR) findings (patient 11, Table 1). A (flair) B (DWI) C (T2) : Right acute basal ganglia infarct with right M2 segment pseudoaneurysm visualized on the T2 weighted imaging, consistent with the patient history of Marfan disease.

 

 

Figure 4: Right transverse and sigmoid sinus thrombosis (patient 17, Table 2). (A) T2-weighted image. (B) MR venogram (2D-TOF). (C) Computed tomography venogram. (D) Computed tomography venogram. No infarct visualized.

 

Keywords: 522 eye movements • 612 neuro-ophthalmology: diagnosis • 754 visual acuity