Stroke risk after ocular cranial nerve palsy – A systematic review and meta-analysis

Shew, William; Wang, Michael T.M.; Danesh‐Meyer, Helen V.

doi:10.1016/j.jocn.2021.12.006

Cited by 4 publications

(8 citation statements)

References 40 publications

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“…This difference between the present study and other studies could be due to the age and underlying disease(s) of the patients. Ocular motor nerve palsy is a significant risk factor for subsequent stroke, and the risk of stroke continues up to 12 years [ 11 – 14 ]; therefore, to prevent future strokes, it is advisable to start antiplatelet therapy for cases of ocular motor nerve palsy with an underlying predisposition.…”

Section: Discussionmentioning

confidence: 99%

“…It often improves spontaneously over time, and follow-up or symptomatic treatment (e.g., prism glasses), depending on the clinical course of the patients, may be attempted. In addition, considering the thrombus formation tendency of COVID-19 vaccines, such as AZ, it would be beneficial to consider antiplatelet therapy for future prognosis and prevention of stroke, especially if there are underlying diseases such as diabetes, hypertension, and hyperlipidemia [ 11 – 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Neuro-ophthalmologic symptoms after coronavirus disease 2019 vaccination: a retrospective study

Kang

Lee

2023

BMC Ophthalmol

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Background There have been several studies on inflammatory ophthalmic diseases; however, few studies have reported neuro-ophthalmological symptoms, such as diplopia and ocular motor nerve palsy, after coronavirus disease 2019 (COVID-19) vaccination. Therefore, this study aimed to report neuro-ophthalmological symptoms in patients after COVID-19 vaccination. Methods This was a retrospective study based on the medical records of 10 patients who visited our ophthalmology clinic in 2021 with symptoms, such as diplopia (nine patients) and decreased visual acuity (one patient), and showed findings, such as ocular motor nerve palsy, after vaccination against COVID-19. Results One patient had third nerve palsy, two had sixth nerve palsy, and five had fourth nerve palsy. One patient complained of subjective binocular diplopia but all test results were normal. One patient presented with decreased visual acuity accompanied by a sudden increase in intraocular pressure and orbital cellulitis in the other eye. The symptoms improved gradually in most patients. Compared with previous studies, this study reported three cases of antiplatelet therapy that was initiated due to the older age of the patients and underlying diseases. Conclusion As COVID-19 vaccines can cause neuro-ophthalmological diseases, such as ocular motor nerve palsy, patients’ age and underlying diseases should be considered while administering them.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neuro-ophthalmologic symptoms after coronavirus disease 2019 vaccination: a retrospective study

Kang

Lee

2023

BMC Ophthalmol

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“…Diabetes mellitus has been identified to be a risk factor of microvascular ischemic ocular motor cranial nerve palsies in previous non–population-based studies (3,4,13,14). We were able to establish this association by finding a 6-fold increase in the OR when we compared the prevalence of diabetes mellitus between microvascular ischemic TNP subjects and controls.…”

Section: Discussionmentioning

confidence: 99%

“…Although other studies have reported on vascular risk factors in microvascular palsies, our study has the benefit of using the REP, which better represents the spectrum of disease at a population level, because it draws from a population-based cohort that does not suffer from referral bias that can occur in studies from tertiary centers and is able to be compared against age-matched controls from the same population (12). Diabetes mellitus has been identified to be a risk factor of microvascular ischemic ocular motor cranial nerve palsies in previous non-population-based studies (3,4,13,14). We were able to establish this association by finding a 6-fold increase in the OR when we compared the prevalence of diabetes mellitus between microvascular ischemic TNP subjects and controls.…”

Section: Discussionmentioning

confidence: 99%

Vascular Risk Factors in Isolated Microvascular Ischemic Third Nerve Palsy: A Population-Based Study

Zhao¹,

Bhatti²,

Fang³

et al. 2022

Journal of Neuro-Ophthalmology

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Background: Although presumed microvascular third nerve palsies (TNP) have been associated with vascular risk factors and/or stroke, these associations have not been explored in a population-based cohort. The purpose of this population-based case-control study was to determine whether these factors are associated with TNPs that had been classified as isolated microvascular ischemic events and determine future risk of mortality. Methods: Participants were subjects .18 years old with new onset of isolated TNP attributed to presumed microvascular ischemia (n = 55) while residing in Olmsted County, Minnesota, from January 1, 1978 to December 31, 2014. Control subjects (n = 55) were randomly selected from the same population and matched for gender, age, and length of medical follow-up. We identified all cases of new-onset isolated presumed microvascular ischemic TNP using the Rochester Epidemiology Project, a record-linkage system of medical records for all patient-physician encounters in Olmsted County, Minnesota. All medical records of cases and controls were reviewed for potential risk factors, including diabetes mellitus, diabetic retinopathy, hypertension, hyperlipidemia, smoking, and symptomatic ischemic stroke. Multivariable and univariate logistic regression analyses were used to compare the prevalence of potential risk factors between microvascular ischemic cases and controls according to the number of subjects, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Kaplan-Meier curves were used to compare mortality between cases and controls. Results: The annual incidence of microvascular ischemic TNP was 1.7 per 100,000. Univariate analysis demonstrated that hypertension (P , 0.001; OR, 4.80; 95% CI, 2.11-11.58), diabetes mellitus (P , 0.001; OR, 6.55; 95% CI, 2.72-17.32), diabetic retinopathy (P = 0.014; OR, 13.50; 95% CI, 2.48-251.55), coronary artery disease (P = 0.047; OR, 2.27; 95% CI, 1.02-5.18), and symptomatic ischemic stroke (P = 0.039; OR, 3.56; 95% CI, 1.07-11.85) all occurred more frequently in patients with microvascular ischemic TNP than controls. In multivariate analysis, only hypertension (OR of 4.14, 95% CI, 1.61-10.65, P , 0.001) and diabetes (OR of 4.12, 95% CI,, P = 0.003) remained independently statistically significant. There was numerically higher mortality in microvascular cases than in controls, but it did not reach statistical significance. Conclusions: There are multiple cardiovascular diseases that are associated with isolated microvascular ischemic TNP, including hypertension, coronary artery disease, diabetes mellitus, diabetic retinopathy, and symptomatic ischemic stroke. Given that the main drivers of this association seem to be diabetes and hypertension, patients with microvascular ischemic TNP should be evaluated for these conditions.

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“…1 Recent studies using optical coherence tomography have provided evidence of retinal thinning in individuals with schizophrenia, suggesting that illness pathophysiology may be detected in the most distal and hence readily accessible part of the central nervous system. [2][3][4][5][6][7][8] These studies have shown inner retinal atrophy, thinning of peripapillary retinal nerve fiber layers and macular ganglion cell and inner plexiform layers, as well as an enlarged cup-disc ratio. This was also confirmed in a large and well-characterized cohort, 9 where individuals with schizophrenia showed an enlargement in cup disc ratio and a decrease in inner retinal thickness compared to healthy controls, beyond what could be attributed to the presence of hypertension and diabetes.…”

Section: Introductionmentioning

confidence: 98%

Genetic susceptibility to schizophrenia through neuroinflammatory pathways is associated with retinal thinning: Findings from the UK-Biobank

Rabe,

Smigielski,

Georgiadis

et al. 2024

Preprint

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The human retina is part of the central nervous system and can be easily and non- invasively imaged through optical coherence tomography. Imaging the retina may provide insights on central nervous system related disorders such as schizophrenia. Here, our objective was to investigate if variations in retinal phenotypes could be at- tributed to common genetic variations conveying a risk of schizophrenia as measured by polygenic risk scores. We used population data from the UK Biobank, including White British and Irish individuals without diagnosed schizoprenia, and estimated a polygenic risk score for schizophrenia based on the newest genome-wide association study (PGC release 2022). We hypothesized that greater genetic susceptibility to schizophrenia is associated with retinal thinning, especially within the macula. To gain additional mechanistic insights, we conducted pathway-specific polygenic risk score associations analyses, focusing on gene pathways that are related to schizophrenia. Of 65484 individuals recruited, 48208 participants with available matching imaging- genetic data were included in the analysis of whom 22427 (53.48%) were female and 25781 (46.52%) were male. 5148 individuals were excluded on the basis of incomplete optical coherence tomog- raphy data (for all phenotypes), 198 individuals based on the use of antipsychotics and 197 individuals with schizophrenia, schizotypal- and delusional disorders. Our robust principal component regression results showed that polygenic risk scores for schizophrenia were associated with retinal thinning while controlling for confounding factors (b = -0.03, p = 0.007). Similarly, we found that polygenic risk for schizophrenia specific to neuroinflammation gene sets revealed significant associations with retinal thinning (b = -0.03, self-contained p = 0.041 (reflecting the level of association), com- petitive p = 0.05 (reflecting the level of enrichment)). These results go beyond previ- ous studies suggesting a relationship between manifested schizophrenia and retinal phenotypes. They indicate that the retina is a mirror reflecting the genetic complex- ities of schizophrenia. These associations also suggest the potential involvement of the neuroinflammatory pathway, with indications of genetic overlap in certain retinal phenotypes. The findings further indicate that this gene pathway in individuals with a high polygenic risk for schizophrenia could contribute through acute-phase proteins to structural changes in the retina.

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Stroke risk after ocular cranial nerve palsy – A systematic review and meta-analysis

Cited by 4 publications

References 40 publications

Neuro-ophthalmologic symptoms after coronavirus disease 2019 vaccination: a retrospective study

Neuro-ophthalmologic symptoms after coronavirus disease 2019 vaccination: a retrospective study

Vascular Risk Factors in Isolated Microvascular Ischemic Third Nerve Palsy: A Population-Based Study

Genetic susceptibility to schizophrenia through neuroinflammatory pathways is associated with retinal thinning: Findings from the UK-Biobank

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