Institutional members access full text with Ovid®

Share this article on:

Risk of Acute Ischemic Stroke in Patients With Monocular Vision Loss of Vascular Etiology

Zhang, Lucy Y., MD, MEng; Zhang, Jason, MD; Kim, Richard K., MD; Matthews, Jared L., MD; Rudich, Danielle S., MD; Greer, David M., MD; Lesser, Robert L., MD; Amin, Hardik, MD

doi: 10.1097/WNO.0000000000000613
Original Contribution

Background: To evaluate the risk of concurrent acute ischemic stroke and monocular vision loss (MVL) of vascular etiology.

Design: Retrospective, cross-sectional study.

Subjects: Patients aged 18 or older diagnosed with MVL of suspected or confirmed vascular etiology who had no other neurologic deficits and who received brain MRI within 7 days of onset of visual symptoms were included.

Methods: A medical record review was performed from 2013 to 2016 at Yale New Haven Hospital. Patients were included if vision loss was unilateral and due to transient monocular vision loss (TMVL), central retinal artery occlusion (CRAO), or branch retinal artery occlusion (BRAO). Any patients with neurologic deficits other than vision loss were excluded. Other exclusion criteria were positive visual phenomena, nonvascular intraocular pathology, and intracranial pathology other than ischemic stroke.

Main Outcome Measures: The presence or absence of acute stroke on diffusion-weighted imaging (DWI) on brain MRI.

Results: A total of 641 records were reviewed, with 293 patients found to have MVL. After excluding those with focal neurologic deficits, there were 41 patients who met the inclusion criteria and received a brain MRI. Eight of the 41 subjects (19.5%) were found to have findings on brain MRI positive for acute cortical strokes. The proportion of lesion positive MRI was 1/23 (4.3%) in TMVL subjects, 4/12 (33.3%) in CRAO subjects, and 2/5 (40%) in BRAO subjects. Brain computed tomography (CT) scans were not able to identify the majority of acute stroke lesions in this study.

Conclusions: Patients with MVL of vascular etiology such as TMVL, CRAO, or BRAO may have up to 19.5% risk of concurrent ischemic stroke, even when there are no other neurologic deficits. These strokes were detected acutely with brain MRI using DWI but were missed on CT.

Department of Ophthalmology and Visual Sciences (LYZ, JZ, JLM, DSR, RLL), Yale University School of Medicine, New Haven, Connecticut; Yale University School of Medicine (RKK), New Haven, Connecticut; The Eye Care Group (DSR, RLL), New Haven, Connecticut; and Department of Neurology (DMG, HA), Yale University School of Medicine, New Haven, Connecticut.

Address correspondence to Jason Zhang, MD, Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, 40 Temple Street, Suite 3D, New Haven, CT 06510; E-mail:

Presented at the American Academy of Ophthalmology Annual Meeting, November 14–17, 2015, Las Vegas, NV.

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the full text and PDF versions of this article on the journal's Web site (

© 2018 by North American Neuro-Ophthalmology Society