Transocular sonography in acute arterial occlusions of the eye in elderly patients: Diagnostic value of the spot sign

Czihal, Michael; Lottspeich, Christian; Köhler, Anton; Prearo, Ilaria; Hoffmann, Ulrich; Priglinger, Siegfried; Mackert, Marc J.

doi:10.1371/journal.pone.0247072

Cited by 11 publications

(13 citation statements)

References 22 publications

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“…Additional imaging modalities could potentially enhance the diagnostic workflow. There is evidence that a positive retrobulbar spot sign visualized by ultrasound could be associated with a poor response to IVT and could therefore be a contraindication ( 15 , 22 , 23 ). Retinal diffusion restriction visualized by diffusion-weighted magnetic resonance imaging (DWI-MRI) may provide additional information ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Inner Retinal Layer Hyperreflectivity Is an Early Biomarker for Acute Central Retinal Artery Occlusion

et al. 2022

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PurposeTo investigate inner retinal hyperreflectivity on optical coherence tomography (OCT) as a potential biomarker indicating acute central retinal artery occlusion (CRAO).MethodsA total of 56 patients at two university hospitals with acute CRAO (symptom onset ≤48 h) were included in this retrospective study. The optical intensity of the inner retinal layers was determined in both eyes and the relationship between symptom onset and inner retinal layer optical intensity in OCT scans compared to the unaffected fellow eye was analyzed. Several differential diagnoses [central retinal vein occlusion, anterior ischemic optic neuropathy, diabetic macular edema, and subretinal fibrosis/disciform scar (Junius-Kuhnt)] served as controls to validate optical intensity-based diagnosis of CRAO.ResultsCRAO strongly correlated with an increased inner retinal layer hyperreflectivity in this cohort with acute CRAO with a time since symptom onset ranging from 1.1 to 48.0 h. Receiver operating characteristic (ROC) analysis showed an area under the curve of 0.99 to confirm CRAO with a true positive rate of 0.93 and a false positive rate of 0.02. No correlation between optical intensity and time since symptom onset was noticeable. None of the differential diagnoses did show an elevated optical intensity of the inner retinal layers as it was detectable in CRAO.ConclusionOCT-based determination of inner retinal layer hyperreflectivity is a very promising biomarker for a prompt diagnosis of CRAO in an emergency setting. This may be of major interest to speed up the administration of a possible thrombolytic treatment.

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Section: Discussionmentioning

confidence: 99%

Inner Retinal Layer Hyperreflectivity Is an Early Biomarker for Acute Central Retinal Artery Occlusion

et al. 2022

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“…It is therefore vital to continue publishing on the use of POCUS, in the diagnosis of CRAO, to raise awareness among the medical community and eliminate this variability. Albeit small studies, the sensitivity (83%) and specificity (100%) as well as the strong interobserver agreement (Cohen's kappa 0.98) of POCUS for CRAO are worthy of our confidence in this tool [15,16]. Authors concede that it is not yet the gold standard for this diagnosis because it remains unknown what percentage of patients with a confirmed CRAO by fundus exam and retinal angiography have this ultrasound finding.…”

Section: Discussionmentioning

confidence: 99%

Detection of Central Retinal Artery Occlusion by Point-of-Care Ultrasound in the Emergency Department: A Case Series

Caja¹,

Griffith²,

Roth³

et al. 2021

Cureus

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Central retinal artery occlusion (CRAO) is a rare, but serious, diagnosis that can lead to blindness, most often due to thromboembolic disease. In the emergency department (ED), CRAO can present as acute, painless loss of vision. Physicians need quick ways to rule in this diagnosis due to the time-sensitive nature of the event. We describe two patients in this cases series who present to the same ED with unilateral painless vision loss and histories that include notable risk factors such as thromboembolic and atherosclerotic disease. Upon arrival, point-of-care ultrasound (POCUS) done at the bedside allowed for quick determination of CRAO. The importance of this case series is to emphasize the efficacy of POCUS in evaluating patients with painless vision loss in the ED setting.

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“…Furthermore, this US technique can identify calcic (hyper-echoic) emboli inside the CRA, (retrobulbar “white spot sign”) . This US feature presents an excellent interobserver agreement, rules out a GCA etiology of CRAO, and confirms the embolic cause of CRAO, but does not clearly identify the etiology of the embolus (cardiac, arterio-arterial) [ 63 ].…”

Section: Ultrasonography (Us) In Giant Cell Arteritis (Gca)mentioning

confidence: 99%

Ultrasound Technologies and the Diagnosis of Giant Cell Arteritis

Jianu

Jianu²,

Dan

et al. 2021

Biomedicines

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Giant cell arteritis (GCA) is a primary autoimmune vasculitis that specifically affects medium-sized extracranial arteries, like superficial temporal arteries (TAs). The most important data to be considered for the ultrasound (US) diagnosis of temporal arteritis are stenosis, acute occlusions and “dark halo” sign, which represent the edema of the vascular wall. The vessel wall thickening of large vessels in GCA can be recognized by the US, which has high sensitivity and is facile to use. Ocular complications of GCA are common and consist especially of anterior arterial ischemic optic neuropathies or central retinal artery occlusion with sudden, painless, and sharp loss of vision in the affected eye. Color Doppler imaging of the orbital vessels (showing low-end diastolic velocities and a high resistance index) is essential to quickly differentiate the mechanism of ocular involvement (arteritic versus non-arteritic), since the characteristics of TAs on US do not correspond with ocular involvement on GCA. GCA should be cured immediately with systemic corticosteroids to avoid further visual loss of the eyes.

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Transocular sonography in acute arterial occlusions of the eye in elderly patients: Diagnostic value of the spot sign

Cited by 11 publications

References 22 publications

Inner Retinal Layer Hyperreflectivity Is an Early Biomarker for Acute Central Retinal Artery Occlusion

Inner Retinal Layer Hyperreflectivity Is an Early Biomarker for Acute Central Retinal Artery Occlusion

Detection of Central Retinal Artery Occlusion by Point-of-Care Ultrasound in the Emergency Department: A Case Series

Ultrasound Technologies and the Diagnosis of Giant Cell Arteritis

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