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Low Endogenous Recanalization in Embolic Central Retinal Artery Occlusion—The Retrobulbar “Spot Sign”
Author(s) -
Altmann Mathias,
Ertl Michael,
Helbig Horst,
Schömig Beate,
Bogdahn Ulrich,
Gamulescu MariaAndreea,
Schlachetzki Felix
Publication year - 2014
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/jon.12112
Subject(s) - medicine , central retinal artery occlusion , retinal , cardiology , thrombolysis , retinal artery occlusion , optic nerve , occlusion , stroke (engine) , radiology , ophthalmology , central retinal artery , embolus , engineering , mechanical engineering , myocardial infarction
BACKGROUND AND PURPOSE Central retinal artery occlusion (CRAO) is most often indirectly diagnosed by lack of retinal perfusion. Direct embolus characterization may help to understand the natural course and low response to treatment. In a previous study we identified a hyperechoic signal within the optic nerve and in the central retinal artery (“spot sign”). METHODS In this study we performed a follow‐up investigation in 7 patients with CRAO and positive spot sign indicating the embolic cause of the occlusion after a median interval of 17 months (range 11‐38 months) using a battery of tests (ocular color‐coded sonography, optic coherence tomography [OCT], fundoscopy, amongst others). RESULTS The spot sign persisted in all patients, none had high‐grade internal carotid artery stenosis, stroke or transient ischemic attacks. Four patients were completely blind, 3 patients were able to recognize hand movements. OCT demonstrated retinal atrophy, and fundoscopy revealed only minimal arterial perfusion. CONCLUSIONS The hyperechoic spot sign may be an important predictive prognostic marker for persistent loss of vision. Its persistence may indicate calcified or cholesterol emboli and may explain the low therapeutic success rate to thrombolysis. Further studies on their origin and significance in atherosclerotic disease are warranted.