title: Ophthalmologic findings in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy: a cross-sectional study.
abstract: OBJECTIVE
  To determine the ophthalmologic findings, especially the nature of retinal vascular changes, and their clinical significance in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), a disease that causes migraine, recurrent strokes, and finally subcortical vascular dementia.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Thirty-eight CADASIL patients (19 to 61 years old; 20 in a prestroke group, 15 in a stroke group, and 3 in a dementia group), all with the R133C NOTCH3 mutation and including one homozygous patient, underwent a detailed ophthalmologic examination.
  
  
  METHODS
  Common cardiovascular risk factors were evaluated. Ophthalmologic examination included best-corrected visual acuity, anterior- and posterior-segment biomicroscopy, and measurement of intraocular pressure. In 33 patients and 16 healthy controls (20-64 years old), retinal fundus photographs were taken. Diameters of all arterioles and venules located in the area from 0.5 to 1.0 disc diameters from the optic disc margin were measured with a computer-based program and arteriole-to-venule (A/V) ratios were calculated from digitized photographs.
  
  
  RESULTS
  General arterial narrowing and arteriovenous nickings were common. Straightening of the retinal arterioles and a marked wall reflex (n = 6) occurred. The A/V ratio of CADASIL patients was significantly (P< 0.001) lower than that of controls. One patient had one retinal microinfarct and hemorrhages. The homozygous patient had a chorioretinal scar as a sign of circulatory deficiency. Anterior-segment changes included mild iris atrophy (n = 5) and various degrees of lens opacities. Visual acuity was normal in all but 2 patients, who had cataract and amblyopia.
  
  
  CONCLUSIONS
  The generalized arteriopathy of CADASIL causes a wide variety of changes in retinal arterioles but only minimal functional disturbances. These findings are consistent with alterations in arterioles in the cerebral cortex with which the retina and its arterioles are analogous, but contrast with the severe damage of cerebral white matter arterioles.
authors.affiliation: Department of Neurology, University and University Hospital of Turku, Turku, Finland. susanna.roine@tyks.fi
authors.forename: Susanna
authors.initials: S
authors.lastname: Roine
authors.forename: Mika
authors.initials: M
authors.lastname: Harju
authors.forename: Tero T
authors.initials: TT
authors.lastname: Kivelä
authors.forename: Minna
authors.initials: M
authors.lastname: Pöyhönen
authors.forename: Eeva
authors.initials: E
authors.lastname: Nikoskelainen
authors.forename: Seppo
authors.initials: S
authors.lastname: Tuisku
authors.forename: Hannu
authors.initials: H
authors.lastname: Kalimo
authors.forename: Matti
authors.initials: M
authors.lastname: Viitanen
authors.forename: Paula A
authors.initials: PA
authors.lastname: Summanen
mesh_terms: D000328:Adult; D000869:Anterior Eye Segment; D001160:Arterioles / Q000503:physiopathology; D046589:CADASIL / Q000150:complications* / Q000235:genetics / Q000503:physiopathology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005128:Eye Diseases / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications; D009154:Mutation; D009898:Optic Disk; D000071656:Receptor, Notch3; D051880:Receptors, Notch / Q000235:genetics; D012171:Retinal Vessels / Q000503:physiopathology; D014054:Tomography; D014786:Vision Disorders / Q000209:etiology
chemical_list: C499374:NOTCH3 protein, human; D000071656:Receptor, Notch3; D051880:Receptors, Notch