Department of Ophthalmology (RCF, MTB, JJC), Mayo Clinic; Mayo Clinic (OMC), College of Medicine, Rochester, Minnesota; and Departments of Health Sciences Research (ERL, DOH), and Neurology (MTB, JPK, JJC), Mayo Clinic, Rochester, Minnesota.
J Neuroophthalmol. 2020 Sep;40(3):328-332. doi: 10.1097/WNO.0000000000000923.
Nonarteritic anterior ischemic optic neuropathy (NAION) is a common cause of acute optic neuropathy in adults and is associated with vascular risk factors. Owing to the overlapping risk factor profiles between NAION and cerebral stroke, previous studies have produced conflicting results with regard to NAION as an independent risk factor for stroke.
A retrospective chart review was conducted using the Rochester Epidemiology Project database to identify all cases of NAION occurring among Olmsted County, Minnesota residents from January 1, 1990, through December 31, 2016. Stroke events were characterized using clinical and radiologic data. Comparison was made to an age- and sex-matched control group with similar vascular risk factors.
One-hundred four patients with NAION and 104 control subjects were analyzed. Median age at diagnosis was 65 years (range, 40-90 years). Thirteen patients (13%) with NAION and 10 controls (10%) had symptomatic strokes after the age of 40 years. Among patients with NAION, 6 (46%) suffered a stroke before the diagnosis of NAION, 5 (39%) at least 5 months after the NAION diagnosis, and 2 patients (15%) suffered strokes both before and after the NAION. The cumulative probability of symptomatic strokes for patients with NAION was not significantly different than for controls (hazard ratio = 1.50, 95% confidence interval: 0.66-3.42; P = 0.34). There were no cardioembolic strokes within 1 month of the NAION diagnosis. The mechanism of symptomatic strokes did not differ between the 2 groups.
NAION does not confer an increased risk of symptomatic stroke beyond the risk posed by age and existing vascular risk factors.
非动脉炎性前部缺血性视神经病变（NAION）是成年人急性视神经病变的常见原因，与血管危险因素有关。由于 NAION 和脑卒中有重叠的危险因素谱，先前的研究对于 NAION 是否是卒中的独立危险因素得出了相互矛盾的结果。
使用罗切斯特流行病学项目数据库进行回顾性图表审查，以确定明尼苏达州奥姆斯特德县居民在 1990 年 1 月 1 日至 2016 年 12 月 31 日期间发生的所有 NAION 病例。卒中事件的特征是采用临床和影像学数据。将其与具有相似血管危险因素的年龄和性别匹配的对照组进行比较。
共分析了 104 例 NAION 患者和 104 例对照组患者。诊断时的中位年龄为 65 岁（范围，40-90 岁）。13 例（13%）NAION 患者和 10 例（10%）对照组患者在 40 岁后出现症状性卒中。在 NAION 患者中，6 例（46%）在 NAION 诊断前发生卒中，5 例（39%）在 NAION 诊断后至少 5 个月发生卒中，2 例（15%）在 NAION 前后均发生卒中。NAION 患者发生症状性卒中的累积概率与对照组无显著差异（危险比=1.50，95%置信区间：0.66-3.42；P=0.34）。NAION 诊断后 1 个月内无心源性栓塞性卒中。两组之间症状性卒中的发病机制无差异。
NAION 并不会增加年龄和现有血管危险因素之外的症状性卒中风险。
