J.ophthalmol.(Ukraine).2020;5:56-61.

http://doi.org/10.31288/oftalmolzh202055661

Received: 24 June 2020; Published on-line: 27 October 2020


Neuro-ophthalmological abnormalities in patients with ischemic stroke in the setting of a stroke center of a university clinic

T. M. Muratova, L. V. Venger, D. M. Khramtsov, Iu. M. Vorokhta, V. D. Teliushchenko

Odesa National Medical University; Odesa (Ukraine)

E-mail:  yuri.vorokhta@gmail.com

TO CITE THIS ARTICLE: Muratova TM, Venger LV, Khramtsov DM, Vorokhta IuM, Teliushchenko VD. Neuro-ophthalmological abnormalities in patients with ischemic stroke in the setting of a stroke center of a university clinic. J.ophthalmol.(Ukraine).2020;5:56-61. http://doi.org/10.31288/oftalmolzh202055661   



Background: Stroke remains one of the leading causes of death and disability in the world. Most patients with stroke exhibit neuro-ophthalmological abnormalities.

Purpose: To assess the frequency of neuro-ophthalmological abnormalities in patients with stroke in the setting of a stroke center of a university clinic.

Material and Methods: Two hundred and ninety-eight patients with acute ischemic cerebrovascular accidents who were under observation at the stroke service of the Neurology Department of the Center for Reconstructive and Restorative Medicine (University Clinic) of the Odesa National Medical University from January 2016 through December 2019 were included in the study. Frequency of neuro-ophthalmological symptoms was assessed at the first neurological examination visit and after ophthalmologist consultation was obtained.

Results: Of the 298 patients with stroke, most (162; 54%) were men. Mean patient age was 60.4 ± 1.1 years and mean National Institutes of Health Stroke Scale (NIHSS) score was 10.1 ± 0.9. In addition, of the 298 patients, 163 (54.7%) were admitted to the clinic within a day after onset of clinical symptoms of a stroke. Stroke syndromes were categorized into four subtypes, total anterior circulation infarcts (TACI), partial anterior circulation infarcts (PACI), lacunar circulation infarcts (LACI), and posterior circulation infarcts (POCI). PACI were the most common (139 cases or 36.6%), followed by LACI (88 cases or 29.5%), whereas TACI were least common (28 cases or 10.5%). Of special interest were POSI (43 cases or 14.4%). Fourteen patients with POSI (4.7% of the total study patients) had lesions of the midbrain and pons. Neuro-ophthalmological manifestations were found in 88.8% of patients. Of these manifestations, anisocoria was the most common (60.1%), followed by hemianopia (27.9%), diplopia (22.1%) and visuospatial neglect (19.5%), and various oculomotor abnormalities. Internuclear ophthalmoplegia (INO) was found only in 8 cases (2.7%).

Conclusion: Diagnosing neuro-ophthalmological syndromes requires coordinated efforts of the neurologist and ophthalmologist in the setting of a multi-professional team.

Keywords: neuroophthalmology, stroke, diagnosis

 

References

1.Muratova T, Khramtsov D, Stoyanov A, Vorokhta Y. Clinical epidemiology of ischemic stroke: global trends and regional differences. Georgian Med News. 2020 Feb;(299):83-6.

2.Norrving B, Barrick J, Davalos A, Dichgans M, Cordonnier C, Guekht A, et al. Action Plan for Stroke in Europe 2018-2030. Eur Stroke J. 2018 Dec;3(4):309-36. 

Crossref   PubMed 

3.Dutta D, Hellier K, Obaid M, Deering A. Evaluation of a single centre stroke service reconfiguration - the impact of transition from a combined (acute and rehabilitation) stroke unit to a hyperacute model of stroke care. Future Healthc J. 2017 Jun;4(2):99-104 

Crossref    PubMed

4.Rowe FJ; VIS Group. Accuracy of referrals for visual assessment in a stroke population. Eye (Lond). 2011 Feb;25(2):161-7. 

Crossref   PubMed

5.Sacco RL. Stroke Vision 2020: Creating a Roadmap for the Next Decade. Stroke. 2020 Mar;51(3):1040-6. 

Crossref   PubMed

6.Klyushnikov SA, Aziatska GA. [Oculomotor disorders in neurological practice]. Nervnyie bolezni. 2015; 4:41-6. Russian.

7.Rowe FJ, Conroy EJ, Barton PG, Bedson E, Cwiklinski E, Dodridge C, et al. A Randomised Controlled Trial of Treatment for Post-Stroke Homonymous Hemianopia: Screening and Recruitment. Neuroophthalmology. 2016 Jan 19;40(1):1-7. 

Crossref   PubMed

8.Hanna KL, Rowe FJ. Health Inequalities Associated with Post-Stroke Visual Impairment in the United Kingdom and Ireland: A Systematic Review. Neuroophthalmology. 2017 Mar 1;41(3):117-136. 

Crossref   PubMed 

9.Walle KM, Nordvik JE, Becker F, Espeseth T, Sneve MH, Laeng B. Unilateral neglect post stroke: Eye movement frequencies indicate directional hypokinesia while fixation distributions suggest compensational mechanism. Brain Behav. 2019 Jan;9(1):e01170. 

Crossref   PubMed

10.Gorbulina VS, Zatei AO. [Ways to improve neuroophthalmology]. Alleia nauki. 2018;3(7):54-7. Russian.

11.[Order of the Ministry of Health of Ukraine No. 602 issued on 3.08.2012 “On approval and implementation of medical and technological documents on standardization of medical care for ischemic stroke”, as amended and supplemented by Order No. 34 of the Ministry of Health of Ukraine of 15.09.2014]. Access mode: http://search.ligazakon.ua/l_doc2.nsf/link1/MOZ16323.html. Ukrainian.

12.Jadhav AP, Mokin M, Ortega-Gutierrez S, Haussen D, Liebeskind D, Nogueira R, et al. An Appraisal of the 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke. Interv Neurol. 2020 Feb;8(1):55-9. 

Crossref   PubMed 

13.Warner JJ, Harrington RA, Sacco RL, Elkind MSV. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke. Stroke. 2019 Dec;50(12):3331-3332. 

Crossref   PubMed 

14.Markdorf SA, Predtechenskaya EV, Savelov AA, Tulupov AA, Shtark MB. [Neuroimaging and cerebral infarction (stroke)]. Uspekhi fiziologicheskikh nauk. 2018; 49(2): 60-71. Russian.

15.Elkind MS. Stroke Etiologic Classification-Moving From Prediction to Precision. JAMA Neurol. 2017 Apr 1;74(4):388-90. 

Crossref   PubMed

16.Gustov AV, Takhtaev IuV, Sigrianskii KI, Murzin VA. [Practical neuroophthalmology: a guide for doctors]. Nizhnii Novgorod: Publishing House of Nizhnii Novgorod State Medical Academy; 2011. Russian.

17.Khalafian A.A. [Industrial statistics: Quality control, process analysis, experiment planning in the STATISTICA package]. Moscow: Librocom, 2013. Russian. 

18.Blumenfeld H. Neuroanatomy through clinical cases. 2nd ed. Sunderland, MA: Sinauer Associates; 2010.

19.Vázquez-Justes D, Martín-Cucó A, Gallego-Sánchez Y, Vicente-Pascual M. WEBINO syndrome (wall-eyed bilateral internuclear ophthalmoplegia) secondary to ischemic stroke, about a case. Arch Soc Esp Oftalmol. 2020 Apr;95(4):205-208. 

Crossref   PubMed 

20.Vynckier J, Lemmens R. Torsional internuclear ophthalmoplegia in acute ischemic stroke. Neurol Clin Pract. 2019 Apr;9(2):168-9. 

Crossref   PubMed

21.Hanna KL, Rowe FJ. Clinical versus Evidence-based Rehabilitation Options for Post-stroke Visual Impairment. Neuroophthalmology. 2017 Jul 6;41(6):297-305. 

Crossref   PubMed

 

The authors certify that they have no conflicts of interest in the subject matter or materials discussed in this manuscript.