Central retinal artery occlusion as a neuro-ophthalmological emergency: the need to raise public awareness.
central retinal artery occlusion
stroke unit
thrombolysis
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
23
12
2020
accepted:
07
01
2021
pubmed:
17
1
2021
medline:
13
8
2021
entrez:
16
1
2021
Statut:
ppublish
Résumé
Central retinal artery occlusion (CRAO) is a neuro-ophthalmological emergency necessitating adequate and comprehensive diagnosis. Its optimal management and treatment, however, are still under debate. This study aimed at identifying respective areas for improvement. We retrospectively analysed the medical records of patients with CRAO treated in our stroke unit between January 2016 and August 2020. During the observational period, 101 patients with CRAO were admitted. We observed an increase in the rate of patients primarily admitted to the stroke unit from 52.2% to 97.4%. In addition, the thrombolysis rate - with thrombolysis performed on an individual basis - rose from 0% to 14.1%, coinciding with the implementation of an in-hospital management guideline. Almost 60% of all patients presented outside of the 4.5-h time window for thrombolysis; by far the most common reason not to deliver intravenous thrombolysis in our cohort was a prehospital delay to presentation (58.8%), with 44.4% of patients having consulted a private-practice ophthalmologist first. A total of 25 (32.5%) of 77 patients who underwent magnetic resonance imaging (MRI) had accompanying acute ischaemic stroke lesions on diffusion-weighted MRI of the brain. A possible aetiology of CRAO was identified in 41.4% of patients. Public awareness of sudden unilateral visual loss as a presenting sign for stroke should be raised, increasing the chances for timely recognition in a hospital with ophthalmological expertise and a stroke centre. This is essential for ongoing and future prospective trials on this subject.
Sections du résumé
BACKGROUND AND PURPOSE
Central retinal artery occlusion (CRAO) is a neuro-ophthalmological emergency necessitating adequate and comprehensive diagnosis. Its optimal management and treatment, however, are still under debate. This study aimed at identifying respective areas for improvement.
METHODS
We retrospectively analysed the medical records of patients with CRAO treated in our stroke unit between January 2016 and August 2020.
RESULTS
During the observational period, 101 patients with CRAO were admitted. We observed an increase in the rate of patients primarily admitted to the stroke unit from 52.2% to 97.4%. In addition, the thrombolysis rate - with thrombolysis performed on an individual basis - rose from 0% to 14.1%, coinciding with the implementation of an in-hospital management guideline. Almost 60% of all patients presented outside of the 4.5-h time window for thrombolysis; by far the most common reason not to deliver intravenous thrombolysis in our cohort was a prehospital delay to presentation (58.8%), with 44.4% of patients having consulted a private-practice ophthalmologist first. A total of 25 (32.5%) of 77 patients who underwent magnetic resonance imaging (MRI) had accompanying acute ischaemic stroke lesions on diffusion-weighted MRI of the brain. A possible aetiology of CRAO was identified in 41.4% of patients.
DISCUSSION
Public awareness of sudden unilateral visual loss as a presenting sign for stroke should be raised, increasing the chances for timely recognition in a hospital with ophthalmological expertise and a stroke centre. This is essential for ongoing and future prospective trials on this subject.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2111-2114Informations de copyright
© 2021 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Références
Channa R, Zafar SN, Canner JK, Haring RS, Schneider EB, Friedman DS. Epidemiology of Eye-Related Emergency Department Visits. JAMA Ophthalmol. 2016;134(3):312-319.
Vodopivec I, Cestari DM, Rizzo JF 3rd. Management of Transient Monocular Vision Loss and Retinal Artery Occlusions. Semin Ophthalmol. 2017;32(1):125-133.
Sacco RL, Kasner SE, Broderick JP, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064-2089.
Flaxel CJ, Adelman RA, Bailey ST, et al. Retinal and Ophthalmic Artery Occlusions Preferred Practice Pattern(R). Ophthalmology. 2020;127(2):P259-P287.
Arnold AC. Urgent Evaluation of the Patient With Acute Central Retinal Artery Occlusion. Am J Ophthalmol. 2018;196:xvi-xvii.
Biousse V, Newman NJ. Stroke Risk and Risk Factors in Patients With Central Retinal Artery Occlusion. Am J Ophthalmol. 2019;199:262-263.
Hayreh SS. Do Patients With Retinal Artery Occlusion Need Urgent Neurologic Evaluation? Am J Ophthalmol. 2018;196:53-56.
Lavin P, Patrylo M, Hollar M, Espaillat KB, Kirshner H, Schrag M. Stroke Risk and Risk Factors in Patients With Central Retinal Artery Occlusion. Am J Ophthalmol. 2018;196:96-100.
Weimar C, Ringelstein EB, Diener HC. Monitoring stroke units: management, outcome, efficiency. Nervenarzt. 2007;78(8):957-966.
Mir TA, Arham AZ, Fang W, et al. Acute Vascular Ischemic Events in Patients With Central Retinal Artery Occlusion in the United States: A Nationwide Study 2003-2014. Am J Ophthalmol. 2019;200:179-186.
Chodnicki KD, Pulido JS, Hodge DO, Klaas JP, Chen JJ. Stroke Risk Before and After Central Retinal Artery Occlusion in a US Cohort. Mayo Clin Proc. 2019;94(2):236-241.
Ayrignac X, Zagroun C, Coget A, et al. Acute retinal arterial ischaemia: silent brain infarcts prevalence and short-term recurrence. Eur J Neurol. 2020;27(12):2517-2522.
Golsari A, Bittersohl D, Cheng B, et al. Silent Brain Infarctions and Leukoaraiosis in Patients With Retinal Ischemia: A Prospective Single-Center Observational Study. Stroke. 2017;48(5):1392-1396.
Gupta A, Giambrone AE, Gialdini G, et al. Silent Brain Infarction and Risk of Future Stroke: A Systematic Review and Meta-Analysis. Stroke. 2016;47(3):719-725.
French DD, Margo CE, Greenberg PB. Ischemic Stroke Risk in Medicare Beneficiaries with Central Retinal Artery Occlusion: A Retrospective Cohort Study. Ophthalmol Ther. 2018;7(1):125-131.
Rim TH, Han J, Choi YS, et al. Retinal Artery Occlusion and the Risk of Stroke Development: Twelve-Year Nationwide Cohort Study. Stroke. 2016;47(2):376-382.
Youn TS, Lavin P, Patrylo M, et al. Current treatment of central retinal artery occlusion: a national survey. J Neurol. 2018;265(2):330-335.
Rudkin AK, Lee AW, Chen CS. Central retinal artery occlusion: timing and mode of presentation. Eur J Neurol. 2009;16(6):674-677.
Uhr JH, Mishra K, Wei C, Wu AY. Awareness and Knowledge of Emergent Ophthalmic Disease Among Patients in an Internal Medicine Clinic. JAMA Ophthalmol. 2016;134(4):424-431.
Uhr JH, Governatori NJ, Zhang Q(, et al. Training in and comfort with diagnosis and management of ophthalmic emergencies among emergency medicine physicians in the United States. Eye (Lond). 2020;34(9):1504-1511.
Hayreh SS, Zimmerman MB. Amaurosis fugax in ocular vascular occlusive disorders: prevalence and pathogeneses. Retina. 2014;34(1):115-122.
Hayreh SS, Zimmerman MB, Kimura A, Sanon A. Central retinal artery occlusion. Retinal survival time. Exp Eye Res. 2004;78(3):723-736.
Tobalem S, Schutz JS, Chronopoulos A. Central retinal artery occlusion - rethinking retinal survival time. BMC Ophthalmol. 2018;18(1):101.
McLeod D, Beatty S. Evidence for an enduring ischaemic penumbra following central retinal artery occlusion, with implications for fibrinolytic therapy. Prog Retin Eye Res. 2015;49:82-119.
Préterre C, Godeneche G, Vandamme X, et al. Management of acute central retinal artery occlusion: Intravenous thrombolysis is feasible and safe. Int J Stroke. 2017;12(7):720-723.
Mac Grory B, Nackenoff A, Poli S, et al. Intravenous Fibrinolysis for Central Retinal Artery Occlusion: A Cohort Study and Updated Patient-Level Meta-Analysis. Stroke. 2020;51(7):2018-2025.
Nowak RJ, Amin H, Robeson K, Schindler JL. Acute central retinal artery occlusion treated with intravenous recombinant tissue plasminogen activator. J Stroke Cerebrovasc Dis. 2012;21(8):913.
Hayreh SS, Zimmerman MB. Central retinal artery occlusion: visual outcome. Am J Ophthalmol. 2005;140(3):376-391.
A Phase III Randomized, Blind, Double Dummy, Multicenter Study Assessing the Efficacy and Safety of IV THrombolysis (Alteplase) in Patients With acutE Central retInal Artery Occlusion (THEIA), RCT number NCT03197194 [Internet]. https://clinicaltrials.gov/ct2/show/NCT03197194.