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Daniel Rappoport, Hana Leiba, Judith Luckman, Shalom Michowiz, Nitza Goldenberg-Cohen; Ophthalmological Symptoms, Signs and Outcome in Children with Arterial Stroke or Venous Thrombosis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5111.
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To evaluate the role of the ophthalmologist at presentation and during follow-up of children with arterial stroke or venous thrombosis.
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.
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.
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.
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