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Taroza S, Jatužis D, Matijošaitis V, Raugelė S, Valaikienė J. Central retinal artery occlusion or retinal stroke: a neurosonologist's perspective. Front Neurol 2024; 15:1397751. [PMID: 38915799 PMCID: PMC11194405 DOI: 10.3389/fneur.2024.1397751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
In central retinal artery occlusion (CRAO) or retinal stroke, which is usually a vision-threatening condition, timely diagnosis is imperative to improve the chances of retinal preservation and to establish adequate secondary prevention measures. Even though retinal strokes have been traditionally assigned to the field of ophthalmology, while considering reperfusion therapy as the only way to avoid permanent vision loss, we suggest prompt evaluation of CRAO causes (primarily related to cardiovascular risk factors) performed by a well-organized interdisciplinary team (ophthalmologist and neurologist) in a neurovascular center with stroke expertise. Therefore, the most suitable adjunct method for rapidly diagnosing non-arteritic CRAO could be target transorbital ultrasound, performed by an experienced neurologist/neurosonologist in the stroke unit. Consequently, after an ophthalmological assessment, a final decision on thrombolytic therapy could be made. We accept that further research is obviously needed to determine whether transorbital ultrasound could replace ophthalmological investigation in the case of a suspected acute retinal stroke. We assert that retinal stroke requires interdisciplinary treatment in cooperation with neurologists and ophthalmologists, with an additive value for each to achieve the best results for the patient.
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Affiliation(s)
- Saulius Taroza
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
- Klaipėda University Hospital, Klaipėda, Lithuania
| | - Dalius Jatužis
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Vaidas Matijošaitis
- Department of Neurology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Saulius Raugelė
- Klaipėda University Hospital, Klaipėda, Lithuania
- Faculty of Health Sciences, Klaipėda University, Klaipėda, Lithuania
| | - Jurgita Valaikienė
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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McGuire D, Calleja R, Pai E, Bahl A. Emergency Department Doppler Assessment of a Central Retinal Artery Occlusion: Case Report. Clin Pract Cases Emerg Med 2024; 8:115-119. [PMID: 38869332 PMCID: PMC11166078 DOI: 10.5811/cpcem.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/02/2023] [Accepted: 11/16/2023] [Indexed: 06/14/2024] Open
Abstract
Introduction Vision loss is a symptom found frequently in patients presenting to the emergency department (ED). Central retinal artery occlusion (CRAO) is an uncommon yet time-sensitive and critical cause of painless vision loss in which delayed diagnosis can lead to significant morbidity. Emergency medicine literature documents the ability to diagnose a CRAO using ultrasound by identifying the hyperechoic thrombus-coined the retrobulbar spot sign. Case Report We present the case of a patient presenting with painless monocular vision loss for which CRAO was diagnosed in the ED using point-of-care ultrasound enhanced by the utilization of serial Doppler examinations as well as calculation of the central retinal artery resistive index. Conclusion Despite the pre-existing literature on point-of-care ultrasound investigation of central retinal artery occlusion, there are no emergency medicine case reports describing serial examination of the central retinal artery by spectral Doppler or calculation of arterial resistive index to improve this evaluation and monitor progression of the pathology.
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Affiliation(s)
- Duncan McGuire
- Ascension Providence Hospital, Department of Emergency Medicine, Southfield, Michigan
| | - Robert Calleja
- Beaumont Health, Department of Emergency Medicine, Royal Oak, Michigan
| | - Eric Pai
- Beaumont Health, Department of Emergency Medicine, Royal Oak, Michigan
| | - Amit Bahl
- Corewell Health, Department of Emergency Medicine, Royal Oak, Michigan
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Chirurgi R, Duvvi A, Hussain B, Li L, Singh J, Nigussie AH, Hashmi A, Roffe E, Jauhal S, Fasazadeh M, Kalantari H, Hassen GW. Monocular Painless Vision Loss in the Emergency Department: Multipurpose Utility of Point-of-Care Ultrasound. J Emerg Med 2024; 66:192-196. [PMID: 38278678 DOI: 10.1016/j.jemermed.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/04/2023] [Accepted: 10/01/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Eye-related symptoms are a common presentation in the emergency department (ED). The cases range from simple viral conjunctivitis to trauma-related eye injuries. One pathological condition that could lead to vision loss is retinal artery occlusion (RAO). Evaluating a patient with an eye symptom requires thorough eye examination and advanced imaging in certain instances. Consultation with an ophthalmologist is also necessary for cases that require treatment recommendations and further testing. In the ED, point-of-care ultrasound (POCUS) is a commonly used diagnostic tool that can be used for ocular examination. CASE REPORT We reported a case of a 60-year-old man who presented with painless partial right-eye vision loss. POCUS showed decreased flow in the right central retinal artery with an area of the pale retina seen on the image from the retinal camera, suggesting a possible branch RAO. Further examination with POCUS showed plaque formation at the carotid bifurcation, a potential cause of the patient's symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians and other providers should be encouraged to use POCUS to diagnose eye symptoms accurately and promptly. Abnormal findings will prompt immediate specialty consult and early appropriate management. Our case and other reported cases highlight POCUS's reliability and rapid diagnostic ability.
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Affiliation(s)
- Roger Chirurgi
- Department of Emergency Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York
| | - Anisha Duvvi
- Albert Einstein College of Medicine, Bronx, New York
| | - Bisma Hussain
- Department of Emergency Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York
| | - Lucy Li
- Department of Ophthalmology, New York Medical College, Metropolitan Hospital Center, New York, NY
| | - Jaspreet Singh
- Department of Emergency Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York
| | - Abaynesh Haftu Nigussie
- Department of Emergency Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York
| | - Ahmed Hashmi
- Department of Emergency Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York
| | - Estrella Roffe
- Department of Emergency Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York
| | - Sonja Jauhal
- Department of Emergency Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York
| | - Misagh Fasazadeh
- Department of Emergency Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York
| | - Hossein Kalantari
- Department of Emergency Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York
| | - Getaw Worku Hassen
- Department of Emergency Medicine, New York Medical College, Metropolitan Hospital Center, New York, New York
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Casagrande M, Steinhorst NA, Dippel SK, Kück F, Grohmann C, Spitzer MS, Poli S, Feltgen N, Schultheiss M. Central retinal artery occlusion - detection score. Front Med (Lausanne) 2023; 10:1129002. [PMID: 36936219 PMCID: PMC10014563 DOI: 10.3389/fmed.2023.1129002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/07/2023] [Indexed: 03/05/2023] Open
Abstract
Purpose To investigate the sensitivity and specificity of central retinal artery occlusion (CRAO)-Detection Score in diagnosing CRAO via questionnaire and without fundoscopy. Methods This prospective study enrolled 176 emergency patients suffering from acute visual loss, of whom 38 were suffering from CRAO. Before conducting any examination, we administered our questionnaire containing six questions, followed by a thorough ophthalmologic examination to make the diagnosis. Statistical analysis involved a LASSO penalised multivariate logistic regression model. Results Our receiver operating characteristic (ROC) analysis based on a LASSO penalised multivariate logistic regression model showed an area under the curve (AUC) of 0.9 - three out of six questions were selected by LASSO. Interestingly, the unweighted ROC analysis of only two questions (Short CRAO-Detection Score) yielded similar results with an AUC of 0.88. The short CRAO-Detection Score of 2 yielded 14% (4/28) false positive patients. Conclusion This prospective study demonstrates that a high percentage of CRAO patients are detectable with a questionnaire. The CRAO-Detection Score might be used to triage patients suffering acute visual loss, which is important as intravenous fibrinolysis seem to be time-dependent to be effective.
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Affiliation(s)
- Maria Casagrande
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | | | - Fabian Kück
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Carsten Grohmann
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Martin S. Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Sven Poli
- Department of Neurology and Stroke, University of Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Nicolas Feltgen
- Department of Ophthalmology, University Medical Center Göttingen, Göttingen, Germany
| | - Maximilian Schultheiss
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- *Correspondence: Maximilian Schultheiss,
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Terao R, Fujino R, Ahmed T. Risk Factors and Treatment Strategy for Retinal Vascular Occlusive Diseases. J Clin Med 2022; 11:6340. [PMID: 36362567 PMCID: PMC9656338 DOI: 10.3390/jcm11216340] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 07/30/2023] Open
Abstract
Retinal occlusive diseases are common diseases that can lead to visual impairment. Retinal artery occlusion and retinal vein occlusion are included in the clinical entity, but they have quite different pathophysiologies. Retinal artery occlusion is an emergent eye disorder. Retinal artery occlusion is mainly caused by thromboembolism, which frequently occurs in conjunction with life-threatening stroke and cardiovascular diseases. Therefore, prompt examinations and interventions for systemic vascular diseases are often necessary for these patients. Retinal vein occlusion is characterized by retinal hemorrhage and ischemia, which may impair visual function via several complications such as macular edema, macular ischemia, vitreous hemorrhage, and neovascular glaucoma. Even though anti-vascular endothelial growth factor therapy is the current established first-line of treatment for retinal vein occlusion, several clinical studies have been performed to identify better treatment protocols and new therapeutic options. In this review, we summarize the current findings and advances in knowledge regarding retinal occlusive diseases, particularly focusing on recent studies, in order to provide an update for a better understanding of its pathogenesis.
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Affiliation(s)
- Ryo Terao
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Ryosuke Fujino
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan
| | - Tazbir Ahmed
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan
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