Comparison of risk factors in patients with transient and prolonged eye and brain ischemic syndromes

Patients with ischemic stroke, cerebral transient ischemic attacks (TIAs), retinal artery occlusion (RAO), and amaurosis fugax are thought to have similar risk factors and underlying vascular disease. However, if risk factors are different in patients with eye compared with brain symptoms and in those whose symptoms last <24 hours (transient) compared with those lasting >24 hours (prolonged), more focused prevention strategies are possible in the future.

All patients with ischemic stroke, cerebral TIA, RAO, and amaurosis fugax presenting to our hospital from 1994 to 1999 were examined by a stroke physician. Risk factors were documented, and patients underwent carotid Doppler ultrasound.

We registered 1491 patients with ischemic stroke, 580 with cerebral TIA, 79 with RAO, and 138 with amaurosis fugax. Atrial fibrillation was more common in brain than eye events, whether prolonged [ischemic stroke versus RAO: odds ratio (OR), 3.6; 95% confidence interval (CI), 1.1 to 12] or transient (cerebral TIA versus amaurosis fugax: OR, 2.9; 95% CI, 0.7 to 13), and more common in prolonged than transient events, whether brain (stroke versus cerebral TIA: OR, 3.3; 95% CI, 2.1 to 5.1) or eye (RAO versus amaurosis fugax: OR, 2.7; 95% CI, 0.4 to 16). Severe ipsilateral carotid disease was less common in brain than eye events, whether prolonged (ischemic stroke versus RAO: OR, 0.6; 95% CI, 0.3 to 1.0) or transient (cerebral TIA versus amaurosis fugax: OR, 0.4; 95% CI, 0.2 to 0.6).

These data suggest that there are pathogenetic differences between transient and permanent eye and brain ischemic syndromes. Improved understanding of these mechanisms could lead to more effective stroke prevention.