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on March 18, 2004

Stroke. 2004
Published online before print March 18, 2004, doi: 10.1161/01.STR.0000125009.05353.7c
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Submitted on June 10, 2003
Revised on November 7, 2003
Accepted on December 11, 2003

Symptomatic and Asymptomatic Retinal Embolism Have Different Mechanisms

Christine A.C. Wijman MD*; Joao A. Gomes MD; Michael R. Winter MPH; Behrooz Koleini MD; Ippolit C.A. Matjucha MD; Val E. Pochay; and Viken L. Babikian MD

From Department of Neurology (C.A.C.W.), Stanford University Medical Center, Palo Alto, Calif; Department of Neurology (J.A.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Boston University School of Public Health (M.R.W.), Boston, Mass; Departments of Ophthalmology (B.K., I.C.A.M.) and Neurology (V.E.P., V.L.B.), Boston University School of Medicine, Boston, Mass.

* To whom correspondence should be addressed. E-mail: cwijman{at}stanford.edu.

Purpose--To investigate differences between symptomatic and asymptomatic retinal embolism regarding the frequency and source of cerebral microemboli.

Methods--Thirty-seven patients with transient monocular blindness or retinal infarction and 27 patients (29 eyes) with asymptomatic retinal embolism were prospectively enrolled. Patients underwent a transcranial Doppler study and noninvasive imaging of the cervical internal carotid arteries (ICA). The middle cerebral artery (MCA) ipsilateral to the affected eye was monitored for 30 minutes for microembolic signals (MES), which were saved and analyzed offline. Age-matched controls (n=15) had no history of retinal or brain ischemia, <50% ICA stenosis, and normal ophthalmologic examinations.

Results--MES were detected in 0/15 (0%) controls, 11/37 (30%) MCAs in the symptomatic group (P=0.02), and 3/29 (10%) MCAs in the asymptomatic group (P=0.54). Nine of 11 (82%) symptomatic eyes with MES had ipsilateral ICA stenosis of >=50%, as compared with 0/3 (0%) eyes in the asymptomatic group with MES (P=0.03). Both MES and ICA stenosis of >50% were present in 9/37 (24%) cases in the symptomatic and in 0/29 (0%) cases of the asymptomatic group (P=0.0036).

Conclusions--The frequency and potential source of cerebral microemboli in symptomatic and asymptomatic retinal embolism are different. Cerebral microemboli are more frequent in symptomatic patients and are associated with ICA stenosis.
Key words: amaurosis fugax • cerebral embolism • ultrasonography, Doppler, transcranial • cholesterol embolism






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