Central retinal artery occlusion as a neuro‐ophthalmological emergency: the need to raise public awareness. (10th February 2021)

• Record Type: Journal Article
• Authors: Hoyer, Carolin; Kahlert, Christian; Güney, Resul; Schlichtenbrede, Frank; Platten, Michael; Szabo, Kristina
• Is Part Of: European journal of neurology. Volume 28:Number 6(2021)
• Page Start: 2111
• Page End: 2114
• Publication Date: 2021-02-10
• Subjects: central retinal artery occlusion -- thrombolysis -- stroke unit; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.14735
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract: Background and purpose: Central retinal artery occlusion (CRAO) is a neuro‐ophthalmological emergency necessitating adequate and comprehensive diagnosis. Its optimal management and treatment, however, are still under debate. This study aimed at identifying respective areas for improvement. Methods: We retrospectively analysed the medical records of patients with CRAO treated in our stroke unit between January 2016 and August 2020. Results: During the observational period, 101 patients with CRAO were admitted. We observed an increase in the rate of patients primarily admitted to the stroke unit from 52.2% to 97.4%. In addition, the thrombolysis rate – with thrombolysis performed on an individual basis – rose from 0% to 14.1%, coinciding with the implementation of an in‐hospital management guideline. Almost 60% of all patients presented outside of the 4.5‐h time window for thrombolysis; by far the most common reason not to deliver intravenous thrombolysis in our cohort was a prehospital delay to presentation (58.8%), with 44.4% of patients having consulted a private‐practice ophthalmologist first. A total of 25 (32.5%) of 77 patients who underwent magnetic resonance imaging (MRI) had accompanying acute ischaemic stroke lesions on diffusion‐weighted MRI of the brain. A possible aetiology of CRAO was identified in 41.4% of patients. Discussion: Public awareness of sudden unilateral visual loss as a presenting sign for stroke should be raised, increasing the chances for timely recognition in a hospital with ophthalmological expertise and a stroke centre. This is essential for ongoing and future prospective trials on this subject. Abstract : The optimal diagnosis and treatment of patients with central retinal artery occlusion (CRAO) is still controversial. In a retrospective analysis of management pathways of CRAO patients, we observed increased rates of primary stroke admissions from 52.2% to 97.4% and, coinciding with the implementation of in‐house guidelines, of intravenous thrombolysis from 0% to 14.1%. Almost 60% of patients presented >4.5 h after symptom onset. Our findings underscore the need to raise public awareness of acute unilateral vision loss as a potential stroke symptom and the joint application of neuro‐ophthalmological expertise in managing CRAO.