Strokes and vision: The management of ischemic arterial disease affecting the retina and occipital lobe.
Embolic disease of the anterior or posterior vascular territories may lead to disturbance of vision. Although death from this is uncommon, morbidity remains relatively high: Visual field loss may impair or preclude reading and driving and these are important influences on quality of life. Visual symptoms of stroke mean that patients may present to ophthalmologists with isolated visual symptoms, rather than directly to an emergency department. It is important to diagnose stroke and transient ischemic attacks accurately, as well as to manage them appropriately, as they are important harbingers of further cerebrovascular events. Ophthalmologists are therefore well placed to ensure that these patients receive appropriate acute treatment and secondary prevention. This article reviews the evidence for managing patients presenting with visual symptoms of vascular events. It reviews management of ischemic stroke in general, and compares this with management of events involving the anterior circulation by way of transient monocular visual loss or retinal artery occlusion, and posterior circulation by way of transient binocular visual loss or infarction of the visual cortex.
Department of Neuro-Ophthalmology, Moorfields Eye Hospital, London, United Kingdom; Department of Ophthalmology, Royal Prince Alfred Hospital, Sydney, Australia. Electronic address: mitchell.lawlor@sydney.edu.au.
Mitchell
M
Lawlor
Hyperacute Stroke Unit, University College Hospital, London, United Kingdom; Department of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
Richard
R
Perry
Thrombosis & Thrombophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, England.
Beverley J
BJ
Hunt
Department of Neuro-Ophthalmology, Moorfields Eye Hospital, London, United Kingdom; Department of Neuro-Ophthalmology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; Medical Eye Unit, Guy's & St Thomas' NHS Foundation Trust, London, England.
Gordon T
GT
Plant
D001241:Aspirin / Q000627:therapeutic use; D016894:Endarterectomy, Carotid; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000628:therapy*; D009778:Occipital Lobe / Q000473:pathology*; D013508:Ophthalmologic Surgical Procedures; D015356:Retinal Artery Occlusion / Q000175:diagnosis / Q000628:therapy*; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010959:Tissue Plasminogen Activator; D014786:Vision Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*
D010959:Tissue Plasminogen Activator; D001241:Aspirin
branch retinal artery occlusion; central retinal artery occlusion; cerebrovascular accident; giant cell arteritis; transient ischemic attack; transient monocular visual loss