Retinal microvascular abnormalities and subclinical magnetic resonance imaging brain infarct: a prospective study

Cheung, Ning; Mosley, Thomas H.; Islam, Amirul; Kawasaki, Ryo; Sharrett, A. Richey; Klein, Michael L.; Coker, Laura H.; Knopman, David S.; Shibata, Dean; Catellier, Diane J.; Wong, Tien Yin

doi:10.1093/brain/awq127

Cited by 133 publications

(111 citation statements)

References 25 publications

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“…[23][24][25][26][27] There are studies about the microvascular changes in the retina reflecting strokes and vascular dementia. 28,29 There are also separate studies demonstrating that the retina and cerebral structure of migraine patients are affected. It has been shown that RNFL thinning occurs at different quadrants, and there are also studies regarding the relation between migraine and retrobulbar blood flow alterations.…”

Section: Discussionmentioning

confidence: 99%

Retinal Nerve Fibre Layer Thickness of Migraine Patients with or without White Matter Lesions

Şimşek

2016

Neuro-Ophthalmology

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The aim of this study was to determine whether retinal nerve fibre layer (RNFL) thickness is correlated with cerebral white matter lesions (WML) in migraine patients. Forty migraine and 40 healthy subjects were included in this study. The difference in RNFL thickness between the control and a migraine group with WML and a migraine group without WML were investigated using analysis of variance (ANOVA). A Tukey post hoc test was conducted to determine from which group the difference originated. Lower RNFL thicknesses were observed in the migraine patient group where WML was detected using magnetic resonance imaging (MRI), compared with the control group and with the migraine group with no WML. Statistically significant difference was found between the three groups in terms of RNFL thickness. Although there was a statistically significant difference between the control and the migraine group with WML detected with MRI, no statistically significant difference was found in terms of RNFL thickness between the control and the migraine group with no WML related to Tukey post hoc test. Moreover, there was a statistically significant difference between migraine patients with WML and patients without WML in terms of retinal nerve fibre layer thickness. The results indicate that reduction in RNFL detected via optical coherence tomography may be related to cerebral WML in migraine patients. Further studies by neurologists and ophthalmologists are necessary to determine the clinical relevance of the relation between RNFL and cerebral WML. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

Retinal Nerve Fibre Layer Thickness of Migraine Patients with or without White Matter Lesions

Şimşek

2016

Neuro-Ophthalmology

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“…Retinal vascular abnormalities including localized and generalized arteriolar thinning, arteriovenous nicking, and a lower arteriolar/venular diameter ratio have been demonstrated to be significantly associated with eventual stroke and with arterial hypertension as one of the main risk factors for stroke. [3][4][5][6][7][8][9][10][11] These studies on retinal microvascular abnormalities in >10 000 subjects did not examine whether localized RNFLDs as another morphological marker were associated with arterial hypertension or with stroke. In contrast to retinal microvascular abnormalities, a localized RNFLD as detected on ophthalmoscopy or on conventional fundus photographs is an almost qualitative marker of abnormality because it usually does not occur in normal eyes.…”

Section: Discussionmentioning

confidence: 99%

“…1 Because the retina and its vascular system can be regarded as an extracranial part of the central nervous system, assessable by noninvasive ophthalmoscopy, numerous studies were focused on measuring the caliber of the retinal vessels and on assessing retinal microvascular abnormalities in patients who were at risk of, or who developed, a cerebrovascular stroke. [2][3][4][5][6][7][8][9][10][11] Recent investigations have suggested that localized retinal nerve fiber layer defects (RNFLDs) may be an additional morphological retinal sign associated with the cerebrovascular status. 12,13 To test the hypothesis of an association between localized RNFLDs and cerebrovascular stroke, we conducted this study in which we included a hospital-based study group of patients with acute stroke and compared it with a population-based group which was ethnically and regionally adjusted with the study group.…”

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confidence: 99%

Localized Retinal Nerve Fiber Layer Defects and Stroke

Wang

Yang

Wang

et al. 2014

Stroke

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Background and Purpose-Because the blood circulation system of retina and brain are closely related to each other, we examined whether stroke is associated with localized retinal nerve fiber layer defects (RNFLDs). Methods-Patients with acute ischemic stroke as part of a hospital-based study group were compared with the participants of the population-based group Beijing Eye Study. The retina was imaged by spectral-domain optical coherence tomography for the detection of localized RNFLDs. Results-The study included 154 patients with acute ischemic stroke and 2890 subjects from the Beijing Eye Study for whom optical coherence tomographic images of the retinal nerve fiber layer and data on a previous cerebral stroke were available. In logistic regression analysis, acute stroke was significantly associated with localized RNFLDs (P<0.001; odds ratio, 6.23; 95% confidence interval, 4.17-9.30) after adjusting for age, male sex, arterial hypertension, diabetes mellitus, and higher concentration of the C-reactive protein. In a similar manner, previous stroke was associated with localized RNFLDs (P=0.04; odds ratio, 1.48; 95% confidence interval, 1.02-2.16) in multivariate analysis. In a reverse manner, presence of localized RNFLDs was associated with cerebral stroke (P<0.001; odds ratio, 3.54; 95% confidence interval, 2.68-4.67) after adjusting for age, sex, and prevalence of diabetes mellitus. Conclusions-Localized RNFLDs showed a strong association with previous or acute cerebrovascular stroke and vice versa after adjustment for other systemic and ocular factors. Localized RNFLDs that can be assessed by noninvasive optical coherence tomographic imaging may be added to the panoply of retinal morphological features of stroke.

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“…On the other hand, in the Cardiovascular Health Study (17), which was performed in elderly subjects (with a significant proportion of subjects having previous CV disease), cerebral infarcts were associated with retinal microvascular disease (arteriovenous ratio and nicking), but not with retinopathy. Moreover, prospective studies (18) that were also performed in the general population show evidence that the presence of microvascular retinal abnormalities is associated with incident stroke and subclinical infarcts. More recently, the presence of any retinopathy has also been associated with a greater progression of leukoaraiosis (19).…”

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confidence: 99%

Increased Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes and Retinopathy

et al. 2016

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OBJECTIVEWe sought to examine the presence and severity of brain small vessel disease (SVD) in patients with type 2 diabetes and diabetic retinopathy (DR) compared with those without DR. RESEARCH DESIGN AND METHODSWe evaluated 312 patients with type 2 diabetes without previous cardiovascular disease (men 51%; mean age 57 years; age range 40-75 years); 153 patients (49%) had DR. MRI was performed to evaluate the presence and severity (age-related white matter changes scale) of white matter lesions (WMLs) and lacunes, and transcranial Doppler ultrasound was used to measure the Gosling pulsatility index (PI) of the middle cerebral artery (MCA). RESULTSThe prevalence of lesions of cerebral SVD (WML and/or lacunes) was higher in patients with DR (40.2% vs. 30.1% without DR, P = 0.04). Age (P < 0.01) and systolic blood pressure (P = 0.02) were associated with the presence of SVD. The severity of SVD was associated with age and the presence of DR (P < 0.01 and P = 0.01, respectively). Patients with DR showed a higher MCA PI compared with those without DR (P < 0.01). Age, systolic and diastolic blood pressure, and retinopathy and its severity were associated with an increased MCA PI (P < 0.01 for all variables). A positive correlation was found between MCA PI values and the presence and severity of SVD (P < 0.01 for both variables). CONCLUSIONSPatients with type 2 diabetes who have DR have an increased burden of cerebral SVD compared with those without DR. Our findings suggest that the brain is a target organ for microangiopathy, similar to other classic target organs, like the retina.Patients with type 2 diabetes mellitus have an increased risk of cardiovascular (CV) morbidity and mortality. The chronic deleterious effects of hyperglycemia are classically separated into microvascular and macrovascular complications. In addition to the classic target organs of microangiopathy, such as the retina or the kidneys, the brain has also been described more recently as a target organ for diabetic microvascular complications (1).Cerebral small vessel disease (SVD) is the term commonly used to describe a syndrome of clinical, cognitive, neuroimaging, and neuropathological findings that

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Retinal microvascular abnormalities and subclinical magnetic resonance imaging brain infarct: a prospective study

Cited by 133 publications

References 25 publications

Retinal Nerve Fibre Layer Thickness of Migraine Patients with or without White Matter Lesions

Retinal Nerve Fibre Layer Thickness of Migraine Patients with or without White Matter Lesions

Localized Retinal Nerve Fiber Layer Defects and Stroke

Increased Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes and Retinopathy

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