Cerebral magnetic resonance imaging of coincidental infarction and small vessel disease in retinal artery occlusion

Yong Dae Kim,Sang Jun Park,Young Joo Park,Jun Yup Kim,Jihoon Kang,Sung Hyun Baik,Cheolkyu Jung,Se Joon Woo

doi:10.1038/s41598-020-80014-9

Abstract

There are several reports in the literature on the association between non-arteritic retinal artery occlusion (NA-RAO) and acute ischemic stroke. We investigated the burden of small vessel disease (SVD) and cerebral coincident infarction observed on cerebral magnetic resonance imaging (MRI) in patients with newly diagnosed NA-RAO. In this retrospective, observational, case-series study, consecutive patients with NA-RAO who underwent cerebral MRI within one month of diagnosis between September 2003 and October 2018 were included. The classification of NA-RAO was based on ophthalmologic and systemic examinations. We also investigated the co-incident infarction and burden of underlying SVD, which were categorized as white matter hyperintensity lesion (WMH), cerebral microbleeds (CMB), and silent lacunar infarction (SLI). Among the 272 patients enrolled in the study, 18% presented co-incident infarction and 73% had SVD, which included WMH (70%), CMB (14%), and SLI (30%). Co-incident infarction, WMH, and SLI significantly increased with age: co-incident infarction was observed in 8% of young (< 50 years) patients and 30% of old (≥ 70 years) patients. The embolic etiology of RAO (large artery atherosclerosis, cardioembolism, and undetermined etiology) was significantly associated with the prevalence of SVD (82%: 70%: 64%, P = 0.002) and co-incident infarction (30%: 19%: 8%; P = 0.009). Therefore, high co-incidence of acute cerebral infarction and underlying SVD burden warrant careful neurologic examination and appropriate brain imaging, followed by management of NA-RAO. Urgent brain imaging is particularly pertinent in elderly patients with NA-RAO.

Highlights

There are several reports in the literature on the association between non-arteritic retinal artery occlusion (NA-Retinal artery occlusion (RAO)) and acute ischemic stroke
The mean time from onset of symptoms to magnetic resonance imaging (MRI) was significantly less in the central RAO (CRAO) group (3.2 ± 6.0 days) than in the branch RAO (BRAO) group (6.9 ± 9.8 days) (P < 0.001)
There was no significant difference between the CRAO and BRAO groups in the prevalence of hypertension, diabetes mellitus, dyslipidemia, and smoking status

Summary

Introduction

There are several reports in the literature on the association between non-arteritic retinal artery occlusion (NA-RAO) and acute ischemic stroke. We investigated the burden of small vessel disease (SVD) and cerebral coincident infarction observed on cerebral magnetic resonance imaging (MRI) in patients with newly diagnosed NA-RAO. There was a few small studies on the relationship between retinal vascular changes and cerebral S VD28–30, and it has been suggested that retinal vein occlusion and non-arteritic ischemic optic neuropathy are related with cerebral SVD31,32 It is unknown how many SVDs are found in patients with NA-RAO, and in which type of etiology of NA-RAO is commonly related to which type of SVDs. The reason for the lack of research on the link between NA-RAO and SVD is that SVD is an asymptomatic lesion, and SVD is not directly related with the early risk of ischemic stroke after occurrence of RAO. Larger studies are needed to elucidate the role of concurrent brain lesions occurring at the time of RAO diagnosis, which may provide a deeper understanding of the cerebral vascular diseases associated with RAO and the need for systemic evaluation, including cerebral MRI

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