Differential associations of cortical and subcortical cerebral atrophy with retinal vascular signs in patients with acute stroke.
OBJECTIVE
The relationship of cortical and subcortical cerebral atrophy to cerebral microvascular disease is unclear. We aimed to assess the associations of retinal vascular signs with cortical and subcortical atrophy in patients with acute stroke.


METHODS
In the Multi-Centre Retinal Stroke Study, 1360 patients with acute stroke admitted to 2 Australian and 1 Singaporean tertiary hospital during 2005 to 2007 underwent neuroimaging and retinal photography. Cortical and subcortical cerebral atrophy were graded based on standard CT scans. A masked assessment of retinal photographs identified focal retinal vascular signs, including retinopathy and retinal arteriolar wall signs (ie, focal arteriolar narrowing, arteriovenous nicking, arteriolar wall light reflex) and measured quantitative signs (retinal arteriolar and venular caliber).


RESULTS
After adjusting for age, gender, study site, hypertension, hypercholesterolemia, diabetes, and smoking status, none of the retinal vascular signs assessed were associated with cortical atrophy, whereas retinopathy (OR, 1.9; CI, 1.2 to 3.0) and enhanced arteriolar light reflex (OR, 2.0; CI, 1.2 to 3.2) were significantly associated with subcortical atrophy.


CONCLUSIONS
Our finding that certain retinal vascular signs are associated with subcortical but not cortical atrophy, suggests a differential pathophysiology between these 2 cerebral atrophy subtypes and a potential role for small vessel disease underlying subcortical cerebral atrophy.
Baker
Michelle L
ML
Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.
Wang
Jie Jin
JJ
Liew
Gerald
G
Hand
Peter J
PJ
De Silva
Deidre A
DA
Lindley
Richard I
RI
Mitchell
Paul
P
Wong
Meng-Cheong
MC
Rochtchina
Elena
E
Wong
Tien Y
TY
Wardlaw
Joanna M
JM
Hankey
Graeme J
GJ
D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D001315:Australia; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D011859:Radiography; D012160:Retina / Q000473:pathology* / Q000503:physiopathology; D012171:Retinal Vessels / Q000473:pathology* / Q000503:physiopathology; D012307:Risk Factors; D012846:Singapore; D020521:Stroke / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology