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Symptomatic and asymptomatic retinal embolism have different mechanisms
Christine A C Wijman1, Joao A Gomes, Michael R Winter
1Department of Neurology, Stanford University Medical Center, Palo Alto, Calif 94304-1705, USA. cwijman@stanford.edu
Stroke
|March 20, 2004
Summary
Cerebral microemboli are more common in symptomatic retinal embolism and linked to internal carotid artery stenosis. Asymptomatic cases show fewer microemboli and no association with significant stenosis.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Medicine
Background:
- Retinal embolism can be symptomatic or asymptomatic.
- Understanding the source and frequency of cerebral microemboli (MES) is crucial for risk stratification.
Purpose of the Study:
- To compare the incidence and origin of cerebral microemboli between symptomatic and asymptomatic retinal embolism.
- To identify associations between microemboli and internal carotid artery (ICA) stenosis.
Main Methods:
- Prospective enrollment of patients with symptomatic retinal embolism (n=37) and asymptomatic retinal embolism (n=27).
- Transcranial Doppler (TCD) monitoring of the middle cerebral artery (MCA) for microembolic signals (MES).
- Noninvasive imaging of cervical internal carotid arteries (ICA) to assess stenosis.
Main Results:
- Microembolic signals (MES) were detected in 30% of symptomatic cases versus 10% of asymptomatic cases (P=0.54).
- Symptomatic cases with MES frequently showed significant ipsilateral ICA stenosis (>50%) (82%), unlike asymptomatic cases (0%) (P=0.03).
- Combined presence of MES and >50% ICA stenosis was significant in symptomatic (24%) but absent in asymptomatic patients (P=0.0036).
Conclusions:
- Cerebral microemboli differ in frequency and source between symptomatic and asymptomatic retinal embolism.
- Symptomatic retinal embolism is associated with a higher incidence of cerebral microemboli and significant ICA stenosis.