Association between retinal diseases and incidence of different subtypes of stroke_West China Medical Journal

Authors：

WEI Chenchen ¹ , ZHANG Shuting ¹ , PAN Ruosu ² , JIN Yuxi ² ,  LIU Ming ¹

1. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LIU Ming, Email: wyplmh@hotmail.com

Keywords：

Ischemic stroke; Intracerebral hemorrhage; Retinal diseases; Retinal photography

DOI：

10.7507/1002-0179.201805073

Video：

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ObjectiveTo conduct an objective record of stroke patient’s retinal diseases by retinal photography, and analyze the incidence of various retinal diseases between different subtypes of stroke.MethodsFrom June to October 2007, the consecutive cases of stroke admitted to the Department of Neurology, West China Hospital of Sichuan University were prospectively registered. Ischemic stroke patients were classified into different subtypes by the Oxfordshire Community Stroke Project criteria, and intracerebral hemorrhage (ICH) patients were classified based on the clinical manifestation and neuroimaging. We collected other clinical data associated with the incidence of stroke. The retinal abnormalities including retinopathy, arteriovenous nicking and arteriolar narrowing were recorded. Multivariate logistic regression was performed to investigate the relationship between retinal abnormalities and stroke.ResultsThis study included 199 patients with ischemic stroke and 95 patients with ICH. Among the patients with ischemic stroke, 43 (21.6%) had retinopathy, 52 (26.1%) presented with arteriovenous nicking, and 43 (21.6%) developed arteriolar narrowing. Among the patients with ICH, retinopathy occurred in 23 (24.2%), arteriovenous nicking occurred in 14 (14.7%), and arteriolar narrowing occurred in 25 (26.3%). In multivariate analysis, retinopathy was independently associated with partial anterior circulation infarct (PACI) (P=0.029) and anterior ICH (P=0.041).ConclusionsRetinopathy is independently associated with PACI and anterior ICH. Further community-based study with large sample should be conducted to confirm the predictive value of retinal diseases on the incidence of anterior stroke.

Citation： WEI Chenchen, ZHANG Shuting, PAN Ruosu, JIN Yuxi, LIU Ming. Association between retinal diseases and incidence of different subtypes of stroke. West China Medical Journal, 2018, 33(6): 678-683. doi: 10.7507/1002-0179.201805073 Copy

1.	Zhou M, Wang H, Zhu J, et al. Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet, 2016, 387(10015): 251-272.
2.	GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 2015, 385(9963): 117-171.
3.	Liu L, Wang D, Wong KS, et al. Stroke and stroke care in China: huge burden, significant workload, and a National priority. Stroke, 2011, 42(12): 3651-3654.
4.	中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組.中國急性缺血性腦卒中診治指南2014. 中華神經科雜志, 2015, 48(4): 246-257.
5.	I?zecka J, Stelmasiak Z. Practical significance of ischemic stroke OCSP (Oxfordshire Community Stroke Project) classification. Neurol Neurochir Pol, 2000, 34(1): 11-22.
6.	Mead GE, Wardlaw JM, Dennis MS, et al. Relationship between pattern of intracranial artery abnormalities on transcranial doppler and Oxfordshire Community Stroke Project clinical classification of ischemic stroke. Stroke, 2000, 31(3): 714-719.
7.	中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組.中國腦出血診治指南(2014). 中華神經科雜志, 2015, 48(6): 435-444.
8.	Steiner T, Boesel J. Options to restrict hematoma expansion after spontaneous intracerebral hemorrhage. Stroke, 2010, 41(2): 402-409.
9.	Sudlow CL, Warlow CP. Comparable studies of the incidence of stroke and its pathological types: results from an international collaboration. International Stroke Incidence Collaboration. Stroke, 1997, 28(3): 491-499.
10.	Hubbard LD, Brothers RJ, King WN, et al. Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the Atherosclerosis Risk in Communities Study. Ophthalmology, 1999, 106(12): 2269-2280.
11.	吳麗娥, 劉鳴. 缺血性腦卒中TOAST病因分型及研究進展. 中風與神經疾病雜志, 2005, 22(1): 85-87.
12.	Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol, 2010, 9(7): 689-701.
13.	Yatsuya H, Folsom AR, Wong TY, et al. Retinal microvascular abnormalities and risk of lacunar stroke: Atherosclerosis Risk in Communities Study. Stroke, 2010, 41(7):1349-1355.
14.	van Leiden HA, Dekker JM, Moll AC, et al. Risk factors for incident retinopathy in a diabetic and nondiabetic population: the hoorn study. Arch ophthalmol, 2003, 121(2): 245-251.
15.	Kwon HM, Kim BJ, Oh JY, et al. Retinopathy as an indicator of silent brain infarction in asymptomatic hypertensive subjects. J Neurol Sci, 2007, 252(2): 159-162.
16.	van den Born BJ, Hulsman CA, Hoekstra JB, et al. Value of routine funduscopy in patients with hypertension: systematic review. BMJ, 2005, 331(758): 73.
17.	Wong TY, Klein R, Sharrett AR, et al. The prevalence and risk factors of retinal microvascular abnormalities in older persons: the Cardiovascular Health Study. Ophthalmology, 2003, 110(4): 658-666.

1. Zhou M, Wang H, Zhu J, et al. Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet, 2016, 387(10015): 251-272.
2. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 2015, 385(9963): 117-171.
3. Liu L, Wang D, Wong KS, et al. Stroke and stroke care in China: huge burden, significant workload, and a National priority. Stroke, 2011, 42(12): 3651-3654.
4. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組.中國急性缺血性腦卒中診治指南2014. 中華神經科雜志, 2015, 48(4): 246-257.
5. I?zecka J, Stelmasiak Z. Practical significance of ischemic stroke OCSP (Oxfordshire Community Stroke Project) classification. Neurol Neurochir Pol, 2000, 34(1): 11-22.
6. Mead GE, Wardlaw JM, Dennis MS, et al. Relationship between pattern of intracranial artery abnormalities on transcranial doppler and Oxfordshire Community Stroke Project clinical classification of ischemic stroke. Stroke, 2000, 31(3): 714-719.
7. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組.中國腦出血診治指南(2014). 中華神經科雜志, 2015, 48(6): 435-444.
8. Steiner T, Boesel J. Options to restrict hematoma expansion after spontaneous intracerebral hemorrhage. Stroke, 2010, 41(2): 402-409.
9. Sudlow CL, Warlow CP. Comparable studies of the incidence of stroke and its pathological types: results from an international collaboration. International Stroke Incidence Collaboration. Stroke, 1997, 28(3): 491-499.
10. Hubbard LD, Brothers RJ, King WN, et al. Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the Atherosclerosis Risk in Communities Study. Ophthalmology, 1999, 106(12): 2269-2280.
11. 吳麗娥, 劉鳴. 缺血性腦卒中TOAST病因分型及研究進展. 中風與神經疾病雜志, 2005, 22(1): 85-87.
12. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol, 2010, 9(7): 689-701.
13. Yatsuya H, Folsom AR, Wong TY, et al. Retinal microvascular abnormalities and risk of lacunar stroke: Atherosclerosis Risk in Communities Study. Stroke, 2010, 41(7):1349-1355.
14. van Leiden HA, Dekker JM, Moll AC, et al. Risk factors for incident retinopathy in a diabetic and nondiabetic population: the hoorn study. Arch ophthalmol, 2003, 121(2): 245-251.
15. Kwon HM, Kim BJ, Oh JY, et al. Retinopathy as an indicator of silent brain infarction in asymptomatic hypertensive subjects. J Neurol Sci, 2007, 252(2): 159-162.
16. van den Born BJ, Hulsman CA, Hoekstra JB, et al. Value of routine funduscopy in patients with hypertension: systematic review. BMJ, 2005, 331(758): 73.
17. Wong TY, Klein R, Sharrett AR, et al. The prevalence and risk factors of retinal microvascular abnormalities in older persons: the Cardiovascular Health Study. Ophthalmology, 2003, 110(4): 658-666.

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