Departments of Ophthalmology (KSC, MRD, VDR, JAL) and Radiology (ENM), Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Neuroophthalmol. 2024 Jun 1;44(2):226-231. doi: 10.1097/WNO.0000000000001974. Epub 2023 Aug 16.
Cerebral vascular malformations (CVMs) may result in hemorrhage, seizure, neurologic dysfunction, and death. CVMs include capillary telangiectasias, venous malformations, cavernous malformations, and arteriovenous malformations. Cavernous and arteriovenous malformations carry the highest risk of complications. Retinal venous malformations (RVMs) have been proposed as an associated finding. Our objective was to determine the prevalence of RVMs in patients with high-risk CVMs.
We retrospectively reviewed patients diagnosed with cerebral cavernous or arteriovenous malformations (high-risk CVMs) who were evaluated by the ophthalmology service at Northwestern University between 2017 and 2020. Patients were stratified into 3 cohorts based on level of certainty: dilated funduscopic examination (DFE), DFE with any form of ocular imaging, and DFE with complete imaging of the macula. We recorded ophthalmic examination abnormalities, ocular imaging findings, and major CVM complications.
We evaluated 156 patients with high-risk CVMs who had undergone DFE. Ocular imaging of any type was performed in 56 patients, of whom 46 had complete imaging of the macula. Zero RVMs were identified in any cohort (95% confidence interval: 0%-1.9% for the entire cohort, 0%-5.4% for any ocular imaging cohort, and 0%-6.5% for the complete macular imaging cohort). Cerebral hemorrhage or seizure occurred in 15%-33% of patients. Associated visual field defects or cranial nerve palsies were found in 14%-20% of patients.
Zero RVMs were identified in patients with high-risk CVMs. However, neuro-ophthalmic findings were common. Therefore, we recommend neuroimaging for patients with RVMs and neuro-ophthalmic signs or symptoms. In asymptomatic patients with RVMs, a potential algorithm for neuroimaging is proposed.
脑血管畸形（CVM）可导致出血、癫痫发作、神经功能障碍和死亡。CVM 包括毛细血管扩张症、静脉畸形、海绵状血管畸形和动静脉畸形。海绵状和动静脉畸形并发症风险最高。已提出视网膜静脉畸形（RVM）是一种相关发现。我们的目的是确定高危 CVM 患者中 RVM 的患病率。
我们回顾性分析了 2017 年至 2020 年期间在西北大学眼科服务处接受诊断为脑海绵状或动静脉畸形（高危 CVM）的患者。患者根据确定性水平分为 3 个队列：眼底镜检查（DFE）扩张、DFE 加任何形式的眼部影像学检查、DFE 加黄斑完整影像学检查。我们记录了眼科检查异常、眼部影像学发现和主要 CVM 并发症。
我们评估了 156 例接受 DFE 的高危 CVM 患者。56 例患者进行了任何类型的眼部影像学检查，其中 46 例患者进行了黄斑完整影像学检查。在任何队列中均未发现 RVM（整个队列的 95%置信区间为 0%-1.9%，任何眼部影像学检查队列为 0%-5.4%，黄斑完整影像学检查队列为 0%-6.5%）。15%-33%的患者发生脑出血或癫痫发作。14%-20%的患者存在相关视野缺损或颅神经麻痹。
在高危 CVM 患者中未发现 RVM。然而，神经眼科发现很常见。因此，我们建议对有 RVM 和神经眼科症状或体征的患者进行神经影像学检查。在无症状的 RVM 患者中，提出了一种潜在的神经影像学算法。
