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EMedHome's Clinical Pearl

Think of CRAO as a Stroke

doi: 10.1097/01.EEM.0000552788.57326.f3
EMedHome's Clinical Pearl


Central retinal artery occlusion is analogous to an ischemic stroke, usually the result of an embolus from a carotid or cardiac source. CRAO patients are at increased risk of ischemic stroke, particularly the first week after the occlusion. (Ophthalmology 2015;122[11]:2336.)

A recent study evaluated the diagnostic yield of an inpatient stroke workup in patients with acute CRAO. (Am J Ophthalmol 2018 Aug 25. doi: 10.1016/j.ajo.2018.08.027. [Epub ahead of print].) Thirty-seven percent of 103 patients with CRAO had critical carotid disease ipsilateral to the CRAO, 37 percent also had acute stroke, and 25 percent underwent an urgent surgical intervention, usually carotid revascularization, valve replacement, or coronary artery intervention.

The combined stroke-MI-death rate at 24 months was 32 percent, suggesting that CRAO confers a risk at least equal to a high-risk TIA. This study was limited to a single academic medical center, but the high rate of serious comorbid disease and the high rate of subsequent stroke, MI, and death showed that CRAO was a stroke equivalent and that patients presenting with an acute CRAO should quickly undergo thorough risk factor evaluation and intervention.

Given that CRAO patients typically present to the ED, this has important implications for appropriate disposition and evaluation by emergency physicians.

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