From the Departments of Neurology (C.A.C.W., V.L.B., V.E.P.),
Ophthalmology (I.C.A.M., B.K.), and Radiology (C.H.), Boston University School
of Medicine, and the Boston University School of Public Health (M.R.W.),
Boston, Mass.
Correspondence to V.L. Babikian, MD, Department of Neurology, Boston University School of Medicine and Boston Veterans Administration Medical Center, 150 S Huntington Ave, Boston, MA 02130.
Background and Purpose—We
investigated the frequency of cerebral microembolism detected by
transcranial Doppler ultrasonography in patients with
clinical evidence of retinal ischemia, including transient
monocular blindness, central and branch retinal artery infarction, and
ischemic oculopathy, and assessed its correlation with carotid
artery stenosis.
Methods—Records of 331 consecutive patients examined during a
47-month period at the Neurovascular Laboratory were reviewed. Of the
original 453 intracranial arteries, 186 middle cerebral arteries (MCAs)
satisfied qualifying criteria that excluded patients with cardiac
embolic sources. Forty-five MCAs ipsilateral to the
symptomatic eye constituted the study group. The control
group consisted of 141 asymptomatic MCAs. Microembolus
detection studies were performed on transcranial
Doppler instruments equipped with special software, and the degree
of carotid artery stenosis was measured by cerebral or MR
angiography or by color duplex studies.
Results—Microembolism was detected in 40.0% of study MCAs and
9.2% of controls (P<0.001). In the study group,
microembolic signals were detected in 61.9% of MCAs
tested within a week of symptom onset and 20.8% of those tested
afterward (P<0.001). Severe (
Conclusions—In patients without cardiac embolic sources, cerebral
microembolism is frequently present on the side of retinal
ischemia, particularly during the week after onset of symptoms.
It is often associated with severe stenosis or occlusion of the
ipsilateral carotid artery.
© 1998 American Heart Association, Inc.
Original Contributions
Cerebral Microembolism in Patients With Retinal Ischemia
70%) carotid
stenosis or occlusion was more frequent in the study group
(P<0.001). Microembolic signals were
detected in 25.3% and 11.2%, respectively, of MCAs distal to carotid
arteries with 70% to 100% and 0% to 69% stenosis
(P=0.013).
Key Words: cerebral embolism • retina • ultrasonography, Doppler
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