Retinopathy in Ischemic Stroke Subtypes

Background and Purpose— Lacunar stroke is associated with an intrinsic cerebral small vessel disorder of unknown etiology, although possible causes include increased blood–brain barrier permeability. Retinal arterioles are similar to cerebral small vessels and retinopathy occurs secondary to increased blood–retinal barrier permeability. We hypothesized that there would be higher rates of retinopathy in patients with acute lacunar versus cortical stroke. Methods— We prospectively recruited patients presenting with acute lacunar and cortical ischemic stroke. An experienced stroke physician diagnosed and subtyped the stroke based on clinical features and cerebral MRI. We performed 6 dilated digital retinal photographs of each eye in all patients. A carefully trained physician graded retinopathy (one or more of hard or soft exudates, microaneurysms, or hemorrhages) blind to stroke type as definitely present/absent or uncertain. Results— We recruited 220 patients; 6 were excluded with ungradeable photographs leaving 214 patients for analysis (105 lacunar and 109 cortical strokes). Mean age was 68 years (SD, 11 years) and median National Institutes of Health Stroke Scale 2. Similar proportions of each group had diabetes (17% lacunar versus 10% cortical) and hypertension (56% lacunar and 66% cortical). Eighteen percent of lacunar and 19% of cortical patients had any retinopathy. After adjusting for baseline differences in age, hypertension, and diabetes, retinopathy was not associated with ischemic stroke subtype. Conclusions— We have not demonstrated a strong association between retinopathy and ischemic stroke subtype. However, larger samples or assessment of other retinal vascular abnormalities may yield positive associations.