Neuro-ophthalmological abnormalities in cerebrovascular disease

Authors

DOI:

https://doi.org/10.31288/oftalmolzh202416773

Keywords:

neuro-ophthalmology, ischemic optic neuropathy, hypertensive retinal angiopathy, cerebrovascular disease, cerebral small-vessel disease, cerebral stroke, diagnosis

Abstract

Purpose: To assess the incidence of various neuro-ophthalmological symptoms in patients with chronic cerebrovascular disease (CVD).

Material and Methods: This study was conducted at the clinical departments of the Petro Mohyla Black Sea National University (Mykolaiv) in 2018-2022. Two hundred and sixteen patients with CVD were involved in the study. Mean patient age was 62.3 ± 1.2 years and most patients (133 or 60.2%) were males. A neuroophthalmological examination included visual acuity testing, intraocular pressure measurement, perimetry, type of vision and heterophoria assessment, evaluation of ocular motility, convergence, and strabismus in the cardinal positions of gaze, and ophthalmoscopy. In addition, patients had optical coherence tomography with Оptovue Avanti XR apparatus, if indicated.

Results: Of 216 patients, 45 (20.8%) had cerebral small-vessel disease, 157 (72.7%), a prior history of transient ischemic attack (TIA), and 118 (46.1%), a prior history of acute cerebrovascular events (ACVE). All patients exhibited signs of hypertensive angiopathy. Of 216 patients, 22 (10.2%) had grade 3, and 6 (2.8%), grade 4 hypertensive angiopathy. There was evidence of posterior ischemic optic neuropathy in the presence of cerebral small-vessel disease in 27 patients (12.5%). Retinal microvascular changes were seen in 133 patients (61.6%). In addition, 10 patients (4.6%) exhibited isolated retinal hemorrhages, 16 (7.4%), hard exudates, and 1 (6.3%) cotton-wool exudates. Moderate retinal and optic disc edema was seen in 23 patients (10.6%). Isolated homonymous visual field defects were found in 13 patients (6.0%); all these patients had a prior history of ACVE.

Conclusion: In patients with CVD, we found fundus changes which were mostly ischemic and more severe in the presence of cerebral small-vessel disease. There is a need for an integrated multispecialty/interdisciplinary approach to further research on the neuroophthalmological aspect of CVD.

References

GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021 Oct;20(10):795-820. https://doi.org/10.1016/S1474-4422(21)00252-0

Muratova T, Khramtsov D, Stoyanov A, Vorokhta Y. Clinical epidemiology of ischemic stroke: global trends and regional differences. Georgian Med News. 2020 Feb;(299):83-86.

Lamirel C, Newman NJ, Biousse V. Vascular neuro-ophthalmology. Neurol Clin. 2010 Aug;28(3):701-27. https://doi.org/10.1016/j.ncl.2010.03.009

Muratova T, Venger L, Khramtsov D, Teliushchenko V. Neuro-ophthalmological abnormalities in patients with ischemic stroke in the setting of a stroke center of a university clinic. J of Ophthalmology (Ukraine). 2020;5(496):56-61 https://doi.org/10.31288/oftalmolzh202055661

Ishida K, Biousse V. Disease of the Year: Cerebrovascular Disorders. J Neuroophthalmol. 2020 Mar;40(1):1-2. https://doi.org/10.1097/WNO.0000000000000905

Rim TH, Teo AWJ, Yang HHS, Cheung CY, Wong TY. Retinal Vascular Signs and Cerebrovascular Diseases. J Neuroophthalmol. 2020 Mar;40(1):44-59. https://doi.org/10.1097/WNO.0000000000000888

Mac Grory B, Schrag M, Biousse V, Furie KL, Gerhard-Herman M, Lavin PJ, et al. Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association. Stroke. 2021 Jun;52(6):e282-e294. Epub 2021 Mar 8. Erratum in: Stroke. 2021 Jun;52(6):e309. https://doi.org/10.1161/STR.0000000000000366

Hayreh SS. Ocular vascular occlusive disorders: natural history of visual outcome. Prog Retin Eye Res. 2014 Jul;41:1-25. Epub 2014 Apr 21. https://doi.org/10.1016/j.preteyeres.2014.04.001

McGrory S, Ballerini L, Doubal FN, Staals J, Allerhand M, Valdes-Hernandez MDC, et al. Retinal microvasculature and cerebral small vessel disease in the Lothian Birth Cohort 1936 and Mild Stroke Study. Sci Rep. 2019 Apr 19;9(1):6320. https://doi.org/10.1038/s41598-019-42534-x

Martin TJ. Horner Syndrome: A Clinical Review. ACS Chem Neurosci. 2018 Feb 21;9(2):177-186. Epub 2017 Dec 20. https://doi.org/10.1021/acschemneuro.7b00405

Alenezi S, Saleem A, Alenezi A, Alhajri O, Khuraibet S, Ameer A. Sudden unilateral eye pain with vision loss related to carotid stump syndrome; A case report and literature review. Int J Surg Case Rep. 2023 May;106:108208. Epub 2023 Apr 15. https://doi.org/10.1016/j.ijscr.2023.108208

Puliaieva IS. [Pre-operative evaluation of patients with carotid artery stenosis]. Naukovyi visnyk Uzhgorodskogo universitetu. Medycyna Series. 2020;1(61);89-92. Ukrainian.

Vasyuta VA, Biloshytskyi VV. Acute vision loss in neurosurgical and neurological disorders. J of Ophthalmology (Ukraine). 2018;6(485):65-70. https://doi.org/10.31288/oftalmolzh201866570

Carvalho V, Cruz VT. Clinical presentation of vertebrobasilar stroke. Porto Biomed J. 2020 Nov 24;5(6):e096. https://doi.org/10.1097/j.pbj.0000000000000096

Moncayo J, Bogousslavsky J. Vertebro-basilar syndromes causing oculo-motor disorders. Curr Opin Neurol. 2003 Feb;16(1):45-50. https://doi.org/10.1097/00019052-200302000-00006

Vickers A, Ponce CP, Zehden J. Alexia without Agraphia. Available at: https://eyewiki.aao.org/Alexia_without_Agraphia

Rusconi E. Gerstmann syndrome: historic and current perspectives. Handb Clin Neurol. 2018;151:395-411. https://doi.org/10.1016/B978-0-444-63622-5.00020-6

Albonico A, Barton J. Progress in perceptual research: the case of prosopagnosia. F1000Res. 2019 May 31;8:F1000 Faculty Rev-765. https://doi.org/10.12688/f1000research.18492.1

Aloizou AM, Labedi A, Richter D, Ceylan U, Schroeder C, Lukas C, Gold R, Krogias C. Cortical blindness as a sign of delayed post-hypoxic encephalopathy: a case report. Int J Neurosci. 2023 May 8:1-3. Epub ahead of print. https://doi.org/10.1080/00207454.2023.2208280

Rumbiak ALE, Sani AF, Kurniawan D, Ahadiyati I. Bilateral gradual cortical blindness due to hemodynamic stroke: A case report. Radiol Case Rep. 2023 Feb 26;18(5):1657-1661. https://doi.org/10.1016/j.radcr.2023.01.098

Pisella L, Vialatte A, Khan AZ, Rossetti Y. Bálint syndrome. Handb Clin Neurol. 2021;178:233-255. https://doi.org/10.1016/B978-0-12-821377-3.00011-8

Fadelalla M, Kanodia A, Elsheikh M, Ellis J, Smith V, Hossain-Ibrahim K. A case of aneurysmal subarchnoid haemorrhage and superficial siderosis complicated by prospagnosia, simultagnosia and alexia without agraphia. Br J Neurosurg. 2023 Aug;37(4):865-868. Epub 2019 Dec 2. https://doi.org/10.1080/02688697.2019.1687848

Haque S, Vaphiades MS, Lueck CJ. The Visual Agnosias and Related Disorders. J Neuroophthalmol. 2018 Sep;38(3):379-392. https://doi.org/10.1097/WNO.0000000000000556

Kwok JM, Micieli JA. New-onset partial ptosis and double vision. Emerg Med J. 2021 Jan;38(1):20-39. https://doi.org/10.1136/emermed-2020-209540

Ross AG, Jivraj I, Rodriguez G, Pistilli M, Chen JJ, Sergott RC [et al.] Retrospective, Multicenter Comparison of the Clinical Presentation of Patients Presenting With Diplopia From Giant Cell Arteritis vs Other Causes. J Neuroophthalmol. 2019 Mar;39(1):8-13. https://doi.org/10.1097/WNO.0000000000000656

Unwin A, Li Lue D. Basilar Artery Occlusion Syndrome With Diplopia, Ataxia, and Encephalopathy. Am J Phys Med Rehabil. 2021 Oct 1;100(10):e142-e143. https://doi.org/10.1097/PHM.0000000000001695

Vorokhta Y, Klymenko M, Zyuzin V, Usov V. Cerebrocardial continuum in patients after a stroke. Art of Medicine. 202328(4):209-15 https://doi.org/10.21802/artm.2023.4.28.209

Pereira S, Vieira B, Maio T, Moreira J, Sampaio F. Susac's Syndrome: An Updated Review. Neuroophthalmology. 2020 May 1;44(6):355-360. https://doi.org/10.1080/01658107.2020.1748062

Hanany M, Rivolta C, Sharon D. Worldwide carrier frequency and genetic prevalence of autosomal recessive inherited retinal diseases. Proc Natl Acad Sci USA. 2020 Feb 4;117(5):2710-2716. Epub 2020 Jan 21. https://doi.org/10.1073/pnas.1913179117

Kryshtal OO, editor. [Bioethics: From Theory to Practice]. Kyiv: Avitsena Publishing House;2012. Ukrainian.

Costello F, Scott JN. Imaging in Neuro-ophthalmology. Continuum (Minneap Minn). 2019 Oct;25(5):1438-1490. https://doi.org/10.1212/CON.0000000000000783

Duering M, Biessels GJ, Brodtmann A, Chen C, Cordonnier C, de Leeuw FE, et al. Neuroimaging standards for research into small vessel disease-advances since 2013. Lancet Neurol. 2023 Jul;22(7):602-618. https://doi.org/10.1016/S1474-4422(23)00131-X

Clinical Neuro-Ophthalmology. A Practical Guide Ed.: Ulrich Schiefer, Helmut Wilhelm, William Hart Springer, 2007.

Fetisov VS. [STATISTICA statistical data analysis package: a textbook]. Nizhyn: Gogol Nizhyn State University; 2018. Ukrainian.

Tseng RMWW, Rim TH, Shantsila E, Yi JK, Park S, Kim SS [et al.] Validation of a deep-learning-based retinal biomarker (Reti-CVD) in the prediction of cardiovascular disease: data from UK Biobank. BMC Med. 2023 Jan 24;21(1):28. https://doi.org/10.1186/s12916-022-02684-8

Published

2024-02-29

How to Cite

1.
Usov V, Klymenko M, Ziuzin V, Borysenko O. Neuro-ophthalmological abnormalities in cerebrovascular disease. J.ophthalmol. (Ukraine) [Internet]. 2024 Feb. 29 [cited 2024 May 29];(1):67-73. Available from: https://ua.ozhurnal.com/index.php/files/article/view/123

Issue

Section

Clinical Ophthalmology