This Article Full Text Full Text (PDF) All Versions of this Article: 40/2/389    most recent STROKEAHA.108.529388v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Doubal, F. N. Articles by Wardlaw, J. M. Search for Related Content PubMed PubMed Citation Articles by Doubal, F. N. Articles by Wardlaw, J. M. Related Collections Acute Cerebral Infarction Acute Stroke Syndromes Cerebral Lacunes Other imaging

(Stroke. 2009;40:389.)
© 2009 American Heart Association, Inc.

Original Contributions

Retinopathy in Ischemic Stroke Subtypes

Fergus N. Doubal, MRCP; Baljean Dhillon, FRCOphth; Martin S. Dennis, MD Joanna M. Wardlaw, MD

From the Division of Clinical Neurosciences (F.N.D., M.S.D., J.M.W.) and the Princess Alexandra Eye Pavilion (B.D.), University of Edinburgh, Edinburgh, UK.

Correspondence to F.N. Doubal, Division of Clinical Neurosciences, Bramwell Dott Building, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK. E-mail fergus.doubal{at}ed.ac.uk

Background and Purpose— Lacunar stroke is associated with an intrinsic cerebral small vessel disorder of unknown etiology, although possible causes include increased blood-brain barrier permeability. Retinal arterioles are similar to cerebral small vessels and retinopathy occurs secondary to increased blood-retinal barrier permeability. We hypothesized that there would be higher rates of retinopathy in patients with acute lacunar versus cortical stroke.

Methods— We prospectively recruited patients presenting with acute lacunar and cortical ischemic stroke. An experienced stroke physician diagnosed and subtyped the stroke based on clinical features and cerebral MRI. We performed 6 dilated digital retinal photographs of each eye in all patients. A carefully trained physician graded retinopathy (one or more of hard or soft exudates, microaneurysms, or hemorrhages) blind to stroke type as definitely present/absent or uncertain.

Results— We recruited 220 patients; 6 were excluded with ungradeable photographs leaving 214 patients for analysis (105 lacunar and 109 cortical strokes). Mean age was 68 years (SD, 11 years) and median National Institutes of Health Stroke Scale 2. Similar proportions of each group had diabetes (17% lacunar versus 10% cortical) and hypertension (56% lacunar and 66% cortical). Eighteen percent of lacunar and 19% of cortical patients had any retinopathy. After adjusting for baseline differences in age, hypertension, and diabetes, retinopathy was not associated with ischemic stroke subtype.

Conclusions— We have not demonstrated a strong association between retinopathy and ischemic stroke subtype. However, larger samples or assessment of other retinal vascular abnormalities may yield positive associations.

Key Words: etiology • lacunar stroke • retinopathy

This article has been cited by other articles:

				F. N. Doubal, T. J. MacGillivray, P. E. Hokke, B. Dhillon, M. S. Dennis, and J. M. Wardlaw Differences in retinal vessels support a distinct vasculopathy causing lacunar stroke Neurology, May 19, 2009; 72(20): 1773 - 1778. [Abstract] [Full Text] [PDF]

				Z. Aly, F. Taj, and A. K. Kamal Evaluating Ischemic Stroke Subtypes: Does the Retinal Microvasculature Hold Clues to What Lies Beneath? Stroke, May 1, 2009; 40(5): e400 - e400. [Full Text] [PDF]