title: The clinical significance of the asymptomatic Hollenhorst plaque.
abstract: Sixty consecutive patients with visual complaints as the primary symptom of cerebrovascular insufficiency were evaluated with complete cerebral angiography (CCA). Eighteen patients referred for evaluation of asymptomatic Hollenhorst plaques had a 50% incidence of ipsilateral carotid bifurcation disease, but only 16% of these were considered surgically remediable; five of these patients eventually required carotid endarterectomy (CEA). Nine of the 18 patients with asymptomatic Hollenhorst plaques were further evaluated with serial ocular fundus photography: the plaque persisted in all nine patients--in four for more than 6 months and in five for more than 1 year. No patient had transient or fixed retinal or cerebral symptoms. Twenty-six patients with amaurosis fugax showed a 70% incidence of significant bifurcation disease and three had significant intracranial disease; 50% eventually required CEA. Twelve patients with fixed visual deficits (four patients had homonymous hemianopsia, four had retinal artery occlusions, and four had ischemic retinopathies) demonstrated a 100% incidence of bifurcation disease, but in addition 85% had significant intracranial disease; only one of this group had surgically amenable disease. Amaurosis fugax preceded blindness in two patients. Hollenhorst plaque as an isolated phenomenon appears to be a retinal embolic event of uncertain age, with poor predictive power for further embolic events, and not as highly correlated with significant or surgically amenabe carotid bifurcation disease.
mesh_terms: D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000601:surgery; D001160:Arterioles / Q000473:pathology; D001161:Arteriosclerosis / Q000175:diagnosis / Q000601:surgery; D001766:Blindness / Q000209:etiology; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000601:surgery; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000601:surgery; D004691:Endarterectomy; D006801:Humans; D011379:Prognosis; D012160:Retina / Q000098:blood supply*; D014786:Vision Disorders / Q000209:etiology