Cerebral magnetic resonance imaging of coincidental infarction and small vessel disease in retinal artery occlusion

Abstract

There are several reports in the literature on the association between non-arteritic retinal artery occlusion (NA-RAO) and acute ischemic stroke. We investigated the burden of small vessel disease (SVD) and cerebral coincident infarction observed on cerebral magnetic resonance imaging (MRI) in patients with newly diagnosed NA-RAO. In this retrospective, observational, case-series study, consecutive patients with NA-RAO who underwent cerebral MRI within one month of diagnosis between September 2003 and October 2018 were included. The classification of NA-RAO was based on ophthalmologic and systemic examinations. We also investigated the co-incident infarction and burden of underlying SVD, which were categorized as white matter hyperintensity lesion (WMH), cerebral microbleeds (CMB), and silent lacunar infarction (SLI). Among the 272 patients enrolled in the study, 18% presented co-incident infarction and 73% had SVD, which included WMH (70%), CMB (14%), and SLI (30%). Co-incident infarction, WMH, and SLI significantly increased with age: co-incident infarction was observed in 8% of young (< 50 years) patients and 30% of old (≥ 70 years) patients. The embolic etiology of RAO (large artery atherosclerosis, cardioembolism, and undetermined etiology) was significantly associated with the prevalence of SVD (82%: 70%: 64%, P = 0.002) and co-incident infarction (30%: 19%: 8%; P = 0.009). Therefore, high co-incidence of acute cerebral infarction and underlying SVD burden warrant careful neurologic examination and appropriate brain imaging, followed by management of NA-RAO. Urgent brain imaging is particularly pertinent in elderly patients with NA-RAO.

Figure 1

Representative cerebral magnetic resonance imaging of (A). acute infarction, (B). white matter hyperintensity lesion, (C). cerebral microbleeds, and (D). silent lacunar infarction. Arrows indicate the corresponding lesion in each figure.

Figure 2

Graphs showing prevalence (%) of cerebral co-incident acute infarction and small vessel disease including white matter hyperintensity lesion, cerebral microbleeds, and silent lacunar infarction by age at the time of cerebral magnetic resonance imaging. The prevalence of cerebral MRI lesions tends to increase with age except cerebral microbleeds. MRI = magnetic resonance imaging. *Significant difference, P < 0.05, χ² test.