title: Ocular fundus photography of patients with focal neurologic deficits in an emergency department.
abstract: OBJECTIVE
  We evaluated the frequency and predictive value of ocular fundus abnormalities among patients who presented to the emergency department (ED) with focal neurologic deficits to determine the utility of these findings in the evaluation of patients with suspected TIA and stroke.
  
  
  METHODS
  In this cross-sectional pilot study, ocular fundus photographs were obtained using a nonmydriatic fundus camera. Demographic, neuroimaging, and ABCD(2) score components were collected. Photographs were reviewed for retinal microvascular abnormalities. The results were analyzed using univariate statistics and logistic regression modeling.
  
  
  RESULTS
  Two hundred fifty-seven patients presented to the ED with focal neurologic deficits, of whom 81 patients (32%) had cerebrovascular disease (CVD) and 144 (56%; 95% confidence interval: 50%-62%) had retinal microvascular abnormalities. Focal and general arteriolar narrowing increased the odds of clinically diagnosed CVD by 5.5 and 2.6 times, respectively, after controlling for the ABCD(2) score and diffusion-weighted imaging. These fundus findings also significantly differentiated TIA from non-CVD, even after controlling for the ABCD(2) score.
  
  
  CONCLUSIONS
  Focal and general arteriolar narrowing were independent predictors of CVD overall, and TIA alone, even after controlling for the ABCD(2) score and diffusion-weighted imaging lesions. The inclusion of nonmydriatic ocular fundus photographs in the evaluation of patients presenting to the ED with focal neurologic deficits may assist in the differentiation of stroke and TIA from other causes of focal neurologic deficits.
authors.affiliation: From the Departments of Ophthalmology (L.N.V., P.T., V.B., P.G., N.J.N., B.B.B.), Neurology (V.B., N.J.N., B.B.B.), Emergency Medicine (D.W.W.), and Neurological Surgery (N.J.N.), Emory University, Atlanta, GA.
authors.forename: Laurel N
authors.initials: LN
authors.lastname: Vuong
authors.affiliation: From the Departments of Ophthalmology (L.N.V., P.T., V.B., P.G., N.J.N., B.B.B.), Neurology (V.B., N.J.N., B.B.B.), Emergency Medicine (D.W.W.), and Neurological Surgery (N.J.N.), Emory University, Atlanta, GA.
authors.forename: Praneetha
authors.initials: P
authors.lastname: Thulasi
authors.affiliation: From the Departments of Ophthalmology (L.N.V., P.T., V.B., P.G., N.J.N., B.B.B.), Neurology (V.B., N.J.N., B.B.B.), Emergency Medicine (D.W.W.), and Neurological Surgery (N.J.N.), Emory University, Atlanta, GA.
authors.forename: Valérie
authors.initials: V
authors.lastname: Biousse
authors.affiliation: From the Departments of Ophthalmology (L.N.V., P.T., V.B., P.G., N.J.N., B.B.B.), Neurology (V.B., N.J.N., B.B.B.), Emergency Medicine (D.W.W.), and Neurological Surgery (N.J.N.), Emory University, Atlanta, GA.
authors.forename: Philip
authors.initials: P
authors.lastname: Garza
authors.affiliation: From the Departments of Ophthalmology (L.N.V., P.T., V.B., P.G., N.J.N., B.B.B.), Neurology (V.B., N.J.N., B.B.B.), Emergency Medicine (D.W.W.), and Neurological Surgery (N.J.N.), Emory University, Atlanta, GA.
authors.forename: David W
authors.initials: DW
authors.lastname: Wright
authors.affiliation: From the Departments of Ophthalmology (L.N.V., P.T., V.B., P.G., N.J.N., B.B.B.), Neurology (V.B., N.J.N., B.B.B.), Emergency Medicine (D.W.W.), and Neurological Surgery (N.J.N.), Emory University, Atlanta, GA.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Newman
authors.affiliation: From the Departments of Ophthalmology (L.N.V., P.T., V.B., P.G., N.J.N., B.B.B.), Neurology (V.B., N.J.N., B.B.B.), Emergency Medicine (D.W.W.), and Neurological Surgery (N.J.N.), Emory University, Atlanta, GA. bbbruce@emory.edu.
authors.forename: Beau B
authors.initials: BB
authors.lastname: Bruce
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000628:therapy; D010781:Photography; D010865:Pilot Projects