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      Eyes and stroke: the visual aspects of cerebrovascular disease

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          Abstract

          A large portion of the central nervous system is dedicated to vision and therefore strokes have a high likelihood of involving vision in some way. Vision loss can be the most disabling residual effect after a cerebral infarction. Transient vision problems can likewise be a harbinger of stroke and prompt evaluation after recognition of visual symptoms can prevent future vascular injury. In this review, we discuss the visual aspects of stroke. First, anatomy and the vascular supply of the visual system are considered. Then, the different stroke syndromes which involve vision are discussed. Finally, topics involving the assessment, prognosis, treatment and therapeutic intervention of vision-specific stroke topics are reviewed.

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          A review of central retinal artery occlusion: clinical presentation and management.

          D Varma, S Cugati, A Lee … (2013)
          Central retinal artery occlusion (CRAO) is an ophthalmic emergency and the ocular analogue of cerebral stroke. Best evidence reflects that over three-quarters of patients suffer profound acute visual loss with a visual acuity of 20/400 or worse. This results in a reduced functional capacity and quality of life. There is also an increased risk of subsequent cerebral stroke and ischaemic heart disease. There are no current guideline-endorsed therapies, although the use of tissue plasminogen activator (tPA) has been investigated in two randomized controlled trials. This review will describe the pathophysiology, epidemiology, and clinical features of CRAO, and discuss current and future treatments, including the use of tPA in further clinical trials.
          Article 0 comments Cited 104 times – based on 0 reviews     Review now
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            Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis.

            Kenneth Ciuffreda, Neera Kapoor, Daniella Rutner … (2007)
            The purpose of this retrospective study was to determine the frequency of occurrence of oculomotor dysfunctions in a sample of ambulatory outpatients who have acquired brain injury (ABI), either traumatic brain injury (TBI) or cerebrovascular accident (CVA), with associated vision symptoms. Medical records of 220 individuals with either TBI (n = 160) or CVA (n = 60) were reviewed retrospectively. This was determined by a computer-based query spanning the years 2000 through 2003, for the frequency of occurrence of oculomotor dysfunctions including accommodation, version, vergence, strabismus, and cranial nerve (CN) palsy. The majority of individuals with either TBI (90%) or CVA (86.7%) manifested an oculomotor dysfunction. Accommodative and vergence deficits were most common in the TBI subgroup, whereas strabismus and CN palsy were most common in the CVA subgroup. The frequency of occurrence of versional deficits was similar in each diagnostic subgroup. These new findings should alert the clinician to the higher frequency of occurrence of oculomotor dysfunctions in these populations and the associated therapeutic, rehabilitative, and quality-of-life implications.
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              Natural history of homonymous hemianopia.

              V Biousse, M. Lynn, Padmini S. Kedar … (2006)
              To describe the characteristics of spontaneous recovery of homonymous hemianopia (HH). The authors reviewed medical records of all patients with HH confirmed by formal visual field testing and seen in follow-up in their service between 1989 and 2004. Clinical characteristics, causes, neuroradiologic definition of lesion location, final outcome, and evolution of the visual field defects were recorded. The associations among final visual field defect outcome, time from injury, and clinical features were analyzed. A total of 254 patients with 263 HH were included in this study. Spontaneous visual field defect recovery was observed in 101 HH (38.4%). The likelihood of spontaneous recovery decreased with increasing time from injury to initial visual field testing (p = 0.0003). The probability of improvement was related to the time since injury (p = 0.0003) with a 50 to 60% chance of improvement for cases tested within 1 month after injury that decreased to about 20% for cases tested at 6 months after surgery. No other factor was found to correlate with the final outcome of the visual field defects. Improvement after 6 months from injury was mild and usually related to improvement of the underlying disease. Spontaneous improvement of homonymous hemianopia is seen in at least 50% of patients first seen within 1 month of injury. In most cases, the improvement occurs within the first 3 months from injury. Spontaneous improvement after 6 months postinjury should be interpreted with caution as it is most likely related to improvement of the underlying disease or to improvement in the patient's ability to perform visual field testing reliably.
              Article 0 comments Cited 72 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Stroke Vasc Neurol
                Journal ID (iso-abbrev): Stroke Vasc Neurol
                Journal ID (hwp): svnbmj
                Journal ID (publisher-id): svn
                Title: Stroke and Vascular Neurology
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2059-8696
                Publication date Collection: December 2017
                Publication date (Electronic): 6 July 2017
                Volume: 2
                Issue: 4
                Pages: 210-220
                Affiliations
                [1 ] departmentDepartment of Neurology , NorthShore University HealthSystem , Chicago, Illinois, USA
                [2 ] departmentDepartment of Neurology , University of Chicago , Chicago, Illinois, USA
                Author notes
                [Correspondence to ] Dr John H Pula; jpula12009@ 123456gmail.com
                Article
                Publisher ID: svn-2017-000079
                DOI: 10.1136/svn-2017-000079
                PMC ID: 5829892
                PubMed ID: 29507782
                SO-VID: 7f4143a0-e105-4c38-a0fd-ecd0f8ccc951
                Copyright © © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 12 March 2017
                Date revision received : 30 May 2017
                Date accepted : 02 June 2017
                Categories
                Subject: Review
                Subject: 1506
                Custom metadata
                special-feature unlocked

                Keywords: vision,stroke,amaurosis fugax,homonymous hemianopia,diplopia
                Data availability:
                Keywords: vision, stroke, amaurosis fugax, homonymous hemianopia, diplopia

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