Long-Term Disability Outcomes for Patients With Ischemic Stroke Presenting With Visual Deficits

Area of Science:

• Neurology
• Stroke Medicine
• Ophthalmology

Background:

• Ischemic strokes affecting anterior or posterior circulation can cause visual deficits impacting functional ability.
• Thrombolytic therapy is often withheld in patients with visual deficits due to underestimation of severity or missed diagnosis.
• Delayed presentation for acute stroke evaluation leads to missed treatment opportunities.

Purpose of the Study:

• To investigate differences in long-term disability for acute ischemic stroke patients with vs. without visual deficits.
• To explore treatment effects of thrombolytics in patients with visual deficits.
• To analyze if the location of ischemia influences disability outcomes.

Main Methods:

• Retrospective analysis of the Houston Methodist Hospital Outcomes-based Prospective Endpoints in Stroke (HOPES) Registry (2016-2021).
• Included 155 patients with visual deficits (abnormal NIHSS vision scores) and 155 controls.
• Assessed ischemic stroke location, NIHSS scores, thrombolytic therapy, and 90-day functional outcomes (modified Rankin Scale).

Main Results:

• Patients with acute ischemic stroke and visual deficits were four times more likely to have poor functional outcomes at 90 days (OR = 4.05; P < 0.001).
• Severe disability (mRS 4-6) was more common in the visual deficit group (14% vs. 6%; P < 0.05).
• Thrombolytic use and ischemia location (anterior vs. posterior circulation) did not significantly alter disability outcomes in this cohort.

Conclusions:

• Visual deficits in acute ischemic stroke patients are associated with a significantly increased likelihood of worse functional outcomes.
• Rehabilitation strategies targeting visual deficits are necessary to improve patient recovery.
• Larger studies are needed to confirm the role of ischemia location and thrombolytic treatment in outcomes for patients with visual deficits.