November 26 Highlights

Abstract

Kwa et al. prospectively studied a cohort of 179 patients with symptomatic atherosclerotic disease. They found a relation between pathologic changes in the retinal arteries and MRI signs of cerebral small vessel disease (i.e., white matter lesions and lacunes), both in hypertensive and normotensive patients. Retinal photograph. Abnormal crossing is seen (circle); retinal artery deflects the vein. The retinal arteries are also narrowed; diameter is less than half the diameter of the veins (small arrows). Sclerosis of the arteries is also seen; light reflex of the artery is increased with a copper wire phenomenon (large arrow). see page 1536 Commentary by Curtis Benesch, MD, MPH Two major factors limit our ability to reduce the risk of stroke. First, a gap exists between our understanding of effective risk reduction strategies for stroke and the optimal implementation of those strategies.1 Narrowing this gap requires improved physician and patient education and elimination of barriers to treatment. The neurologist has a pivotal role in the process of stroke prevention.1,2 Second, improved stroke prevention demands better understanding of stroke risk factors. Kwa et al. report that retinal arterial pathology correlates with cerebral small vessel disease on MRI in patients with atherosclerotic disease. This correlation is evident in both hypertensive and normotensive patients, suggesting that hypertension is not the sole determinant of small arteriolar pathology. Retinal arteriolar narrowing, however, is strongly associated with blood pressure, even in the normal range.3 High-normal blood pressure is in all probability harmful in patients with cerebral small vessel disease. Findings from Kwa et al. also complement earlier observations that retinal microvascular …