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Type of stroke after transient monocular blindness or retinal infarction of presumed arterial origin
  1. E L L M De Schryver1,
  2. A Algra2,
  3. R C J M Donders3,
  4. J van Gijn1,
  5. L J Kappelle1
  1. 1Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht
  3. 3Department of Neurology, Diakonessenhuis Utrecht, Utrecht
  1. Correspondence to:
 Dr E L L M De Schryver
 University Medical Center Utrecht, H.02.128, PO Box 85500, 3508 GA Utrecht, The Netherlands; e.deschryver{at}neuro.azu.nl

Abstract

Background: Retinal infarction and transient monocular blindness (TMB) are associated with an increased risk of future ischaemic stroke. Little information is available on the type of subsequent ischaemic strokes that may occur (anterior or posterior circulation and small vessel or large vessel).

Aim: To analyse the type of stroke after TMB.

Methods: Patients with transient or permanent retinal ischaemia were selected from three prospective studies: the Dutch TIA Trial, the Dutch Amaurosis Fugax Study and the European/Australian Stroke Prevention in Reversible Ischaemia Trial. On follow-up the type of stroke was classified according to the supply territory and the type of vessel involved.

Results: 654 patients were included. During a mean follow-up of 5.2 years, 42 patients were found to have had a cerebral or retinal infarct, of which 27 occurred in the carotid territory ipsilateral to the symptomatic eye, 9 in the territory of the contralateral carotid artery and 6 were infratentorial strokes. Thirty patients had a large-vessel infarct, four had a small-vessel infarct and eight had a retinal infarct. Characteristics associated with a notable increased risk for subsequent stroke or retinal infarction were age ⩾65 years, a history of stroke, a history of intermittent claudication, diabetes mellitus, Rankin score ⩾3, more than three attacks of retinal ischaemia and any degree of ipsilateral carotid stenosis on duplex ultrasonography observation.

Conclusion: Ischaemic strokes after TMB or retinal infarction were found to be mainly large-vessel infarcts in the territory of the ipsilateral carotid artery. TMB and retinal infarction are probably manifestations of large-vessel disease.

  • DAS, Dutch Amaurosis Fugax Study
  • DTT, Dutch TIA Trial
  • ESPRIT, European/Australian Stroke Prevention in Reversible Ischaemia Trial
  • LILAC, Life Long After Cerebral Ischaemia Study
  • TMB, transient monocular blindness

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Footnotes

  • Published Online First 24 February 2006

  • Funding: All three studies were funded in part by The Netherlands Heart Foundation.

  • Competing interests: None declared.

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