Rojas-Bartolomé Laura, Ayo-Martín Óscar, García-García Jorge, Hernández-Fernández Francisco, Palazón-García Elena, Segura Tomás
Department of Neurology, Complejo Hospitalario Universitario de Albacete, c/Hermanos Falco 37, 02006 Albacete, Spain.
Instituto de Investigación en Discapacidades Neurológicas (IDINE), Facultad de Medicina, Universidad de Castilla-La Mancha, 02008 Albacete, Spain.
J Clin Med. 2022 Mar 15;11(6):1615. doi: 10.3390/jcm11061615.
We aimed to evaluate the diagnostic value of orbital ultrasound in the etiologic diagnosis of central retinal artery occlusion (CRAO). For this purpose, patients with CRAO evaluated at our center between 2011 and 2021 were reviewed. Demographic variables, vascular risk factors and ultrasound findings were collected. An orbital duplex was performed in all cases and complemented with other diagnostic explorations. We attended 36 cases of CRAO. In all patients, orbital ultrasound confirmed the diagnosis of CRAO: in 75% emboli material (spot sign) was observed in CRA and in 25% flow alteration in CRA without visible embolus. The positive spot sign (PSS) group differed from patients with negative spot sign (NSS) in terms of etiology: 8 PSS cases (29.6%) had a major cardioembolic cause, 4 (14.8%) a large vessel atheromatous disease, 15 (55.6%) an undetermined cause. Some 21 (77.8%) PSS patients had some minor cardioembolic cause, mainly calcifications of the left valves. In the NSS group, 2 (22%) were diagnosed with giant cell arteritis (GCA). In CRAO, the ultrasound spot sign could be a guide for the detection of embolic sources. Its absence makes it necessary to consider more strongly the possibility of arteritis. Furthermore, our findings suggest a key role of calcium embolism in PSS patients.
我们旨在评估眼眶超声在视网膜中央动脉阻塞（CRAO）病因诊断中的价值。为此，我们回顾了2011年至2021年在本中心接受评估的CRAO患者。收集了人口统计学变量、血管危险因素和超声检查结果。所有病例均进行了眼眶双功超声检查，并辅以其他诊断性检查。我们共诊治了36例CRAO患者。在所有患者中，眼眶超声均确诊为CRAO：75%的患者在视网膜中央动脉（CRA）中观察到栓子物质（斑点征），25%的患者CRA血流改变但未见栓子。阳性斑点征（PSS）组与阴性斑点征（NSS）组在病因方面存在差异：8例PSS患者（29.6%）有主要的心源性栓塞病因，4例（14.8%）有大血管动脉粥样硬化疾病，15例（55.6%）病因不明。约21例（77.8%）PSS患者有一些轻微的心源性栓塞病因，主要是左瓣膜钙化。在NSS组中，2例（22%）被诊断为巨细胞动脉炎（GCA）。在CRAO中，超声斑点征可为栓子来源的检测提供指导。其不存在使得有必要更强烈地考虑动脉炎的可能性。此外，我们的研究结果提示钙栓塞在PSS患者中起关键作用。
