Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
Department of Ophthalmology, Kangdong Sacred Heart Hospital, Seoul, South Korea.
Sci Rep. 2021 Jan 13;11(1):864. doi: 10.1038/s41598-020-80014-9.
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.
有几项文献报道了非动脉炎性视网膜动脉阻塞（NA-RAO）与急性缺血性卒中之间的关联。我们研究了新诊断的 NA-RAO 患者中脑磁共振成像（MRI）上观察到的小血管疾病（SVD）和脑伴发梗死的负担。在这项回顾性、观察性、病例系列研究中，纳入了 2003 年 9 月至 2018 年 10 月期间诊断后一个月内接受脑 MRI 检查的连续 NA-RAO 患者。NA-RAO 的分类基于眼科和全身检查。我们还研究了伴发梗死和潜在 SVD 的负担，这些负担分为脑白质高信号病变（WMH）、脑微出血（CMB）和无症状腔隙性梗死（SLI）。在纳入研究的 272 名患者中，18%出现伴发梗死，73%存在 SVD，包括 WMH（70%）、CMB（14%）和 SLI（30%）。伴发梗死、WMH 和 SLI 随年龄显著增加：在<50 岁的年轻患者中观察到 8%的伴发梗死，而在≥70 岁的老年患者中观察到 30%的伴发梗死。RAO 的栓塞病因（大动脉粥样硬化、心源性栓塞和未确定病因）与 SVD 的患病率（82%：70%：64%，P=0.002）和伴发梗死（30%：19%：8%；P=0.009）显著相关。因此，急性脑梗死的高伴发率和潜在 SVD 负担需要仔细的神经检查和适当的脑部成像，并对 NA-RAO 进行管理。对于老年 NA-RAO 患者，紧急脑部成像尤为重要。
