Patients with retinal artery occlusion at risk of acute stroke

Acute cerebral ischaemia is detected by magnetic resonance imaging (MRI) in 30 percent of patients with acute central retinal artery occlusion (CRAO) and 25 percent of those with acute branch retinal artery occlusion (BRAO), results of a systematic review and meta-analysis have shown.

“Such high rates support a care pathway of prompt referral of such patients for neurological evaluation and brain imaging,” the investigators said.

A systematic search was performed using PubMed, Medline and Cochrane Library for studies reporting the incidence of acute cerebral ischaemia, detected by MRI, within 7 days from diagnosis of acute CRAO, BRAO and transient monocular vision loss (TMVL) up to January 2019. Random effects model was used to carry out the meta-analysis.

The primary outcome measure was the pooled estimate of incidence of acute cerebral ischaemia in CRAO, BRAO and TMVL cohorts including both neurologically symptomatic and asymptomatic patients, while the secondary outcome measure was the pooled estimate of incidence of asymptomatic acute cerebral ischaemia.

The pooled proportion of acute cerebral ischaemia was 0.30 (95 percent CI, 0.24–0.36) and 0.25 (0.16–0.37) in the CRAO and BRAO cohort, respectively. No statistical heterogeneity was seen in the studies. The TMVL cohort had an 11.8-percent rate of acute cerebral ischaemia.

Moreover, the pooled proportion of asymptomatic acute cerebral ischaemia was 0.22 (0.16–0.28) in the CRAO cohort, 0.29 (0.20–0.41) in the BRAO cohort and 0.08 (0.05–0.15) in the TMVL cohort, without statistical heterogeneity.