title: Retrobulbar Spot Sign Predicts Thrombolytic Treatment Effects and Etiology in Central Retinal Artery Occlusion.
abstract: OBJECTIVE
  Transorbital sonography may help establish diagnosis of central retinal artery occlusion (CRAO). Next to Doppler sonographic proof of CRAO, an intra-arterial spot sign can be detected in some cases. We hypothesized that it reflects calcified components. It may be associated with embolization from atherosclerotic plaques and may negatively influence thrombolysis.
  
  
  METHODS
  Prospective monocenter study of 46 patients with ophthalmologically confirmed CRAO. Systemic tissue-type plasminogen activator thrombolysis was performed when appropriate. All patients received etiologic workup.
  
  
  RESULTS
  CRAO was confirmed by Doppler in all patients. Fifty-nine percent of patients with arterio-arterial embolization were spot sign-positive compared with 20% from cardiac source (P<0.05) and none with vasculitis. Eleven patients underwent thrombolysis. Clinically relevant visual improvement was only found in absence of a spot sign (P<0.05).
  
  
  CONCLUSIONS
  Transbulbar ultrasound is valuable for initial diagnosis and diagnostic workup of CRAO. In the light of inconsistent results of previous thrombolysis trials, ultrasound may identify patients more likely to benefit from thrombolytic treatment.
authors.affiliation: From the Departments of Neurology (M.N., M.K., C.T.) and Ophthalmology (M.G., F.W., K.-H.W., B.L.), Universitaetsklinikum Giessen und Marburg GmbH Giessen Campus, Justus-Liebig-University, Giessen, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.); Department of Neurology, Sana Regio-Klinikum, Pinneberg, Germany (M.N.); and Department of Ophthalmology, General Armed Forces Hospital, Koblenz, Germany (F.W.). max.nedelmann@sana.de.
authors.forename: Max
authors.initials: M
authors.lastname: Nedelmann
authors.affiliation: From the Departments of Neurology (M.N., M.K., C.T.) and Ophthalmology (M.G., F.W., K.-H.W., B.L.), Universitaetsklinikum Giessen und Marburg GmbH Giessen Campus, Justus-Liebig-University, Giessen, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.); Department of Neurology, Sana Regio-Klinikum, Pinneberg, Germany (M.N.); and Department of Ophthalmology, General Armed Forces Hospital, Koblenz, Germany (F.W.).
authors.forename: Michael
authors.initials: M
authors.lastname: Graef
authors.affiliation: From the Departments of Neurology (M.N., M.K., C.T.) and Ophthalmology (M.G., F.W., K.-H.W., B.L.), Universitaetsklinikum Giessen und Marburg GmbH Giessen Campus, Justus-Liebig-University, Giessen, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.); Department of Neurology, Sana Regio-Klinikum, Pinneberg, Germany (M.N.); and Department of Ophthalmology, General Armed Forces Hospital, Koblenz, Germany (F.W.).
authors.forename: Frank
authors.initials: F
authors.lastname: Weinand
authors.affiliation: From the Departments of Neurology (M.N., M.K., C.T.) and Ophthalmology (M.G., F.W., K.-H.W., B.L.), Universitaetsklinikum Giessen und Marburg GmbH Giessen Campus, Justus-Liebig-University, Giessen, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.); Department of Neurology, Sana Regio-Klinikum, Pinneberg, Germany (M.N.); and Department of Ophthalmology, General Armed Forces Hospital, Koblenz, Germany (F.W.).
authors.forename: Klaus-Heiko
authors.initials: KH
authors.lastname: Wassill
authors.affiliation: From the Departments of Neurology (M.N., M.K., C.T.) and Ophthalmology (M.G., F.W., K.-H.W., B.L.), Universitaetsklinikum Giessen und Marburg GmbH Giessen Campus, Justus-Liebig-University, Giessen, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.); Department of Neurology, Sana Regio-Klinikum, Pinneberg, Germany (M.N.); and Department of Ophthalmology, General Armed Forces Hospital, Koblenz, Germany (F.W.).
authors.forename: Manfred
authors.initials: M
authors.lastname: Kaps
authors.affiliation: From the Departments of Neurology (M.N., M.K., C.T.) and Ophthalmology (M.G., F.W., K.-H.W., B.L.), Universitaetsklinikum Giessen und Marburg GmbH Giessen Campus, Justus-Liebig-University, Giessen, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.); Department of Neurology, Sana Regio-Klinikum, Pinneberg, Germany (M.N.); and Department of Ophthalmology, General Armed Forces Hospital, Koblenz, Germany (F.W.).
authors.forename: Birgit
authors.initials: B
authors.lastname: Lorenz
authors.affiliation: From the Departments of Neurology (M.N., M.K., C.T.) and Ophthalmology (M.G., F.W., K.-H.W., B.L.), Universitaetsklinikum Giessen und Marburg GmbH Giessen Campus, Justus-Liebig-University, Giessen, Germany; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M.N.); Department of Neurology, Sana Regio-Klinikum, Pinneberg, Germany (M.N.); and Department of Ophthalmology, General Armed Forces Hospital, Koblenz, Germany (F.W.).
authors.forename: Christian
authors.initials: C
authors.lastname: Tanislav
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015356:Retinal Artery Occlusion / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000639:trends*; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000639:trends*
keywords: central retinal artery occlusion; spot sign; thrombolysis; ultrasound