Purpose: To evaluate the risk of concurrent acute cortical ischemic stroke in the setting of monocular vision loss of vascular etiology.
Design: Retrospective and prospective, cross-sectional study.
Subjects: Patients age 18 or older diagnosed with monocular vision loss of suspected or confirmed vascular etiology who had no other neurologic deficits and who received brain magnetic resonance imaging (MRI) within 7 days of onset of visual symptoms.
Methods: Medical record review was performed from 2013-2016 at Yale-New Haven Hospital. Subjects were included if vision loss was unilateral, permanent or transient, and thought to be due to a vascular etiology such as central retinal artery occlusion (CRAO) or branch retinal artery occlusion (BRAO). Any subjects with neurologic deficits other than vision loss were excluded. Other exclusion criteria were positive visual phenomena, non-vascular intraocular pathology, and intracranial pathology other than ischemic stroke. Institutional Review Board/Ethics Committee approval was obtained.
Main Outcome Measures: Presence or absence of acute cortical stroke on diffusion weighted imaging (DWI) sequence on brain MRI.
Results: A total of 641 records were reviewed, with 293 subjects found to have monocular vision loss. After excluding subjects with focal neurologic deficits, there were 41 subjects who met inclusion criteria and received a brain MRI. 8 of the 41 subjects (19.5%) were found to have brain MRI positive for acute cortical strokes. The proportion of lesion positive MRI was 1/23 (4.3%) in transient monocular vision loss subjects, 4/12 (33.3%) in patients with CRAO, and 2/5 (40%) in BRAO.
Conclusions: Patients with transient or permanent monocular vision loss of vascular etiology such as CRAO or BRAO may have up to 19.5% risk of concurrent cortical ischemic stroke, even when there are no other neurologic deficits. This highlights the importance of urgent stroke evaluation in this patient population.