The Eyes Don't Lie When It Comes to TIAs

The advent of diffusion-weighted magnetic resonance imaging (DWI) has revolutionized the diagnosis of acute stroke, but current brain imaging does not reveal transient ischemic attacks (TIAs). Within one week after a TIA, an estimated 3% to 10% of patients will have a stroke. However, the clinical diagnosis of TIA remains unreliable. Nondilated fundus photography has potential in this context because retinal vascular abnormalities are associated with stroke and TIA risk factors.

In the present study, researchers used nondilated fundus photography with a portable camera in 257 patients with focal neurological deficits who were evaluated in an emergency department for suspected cerebrovascular disease. Emergency physicians examined photographs for retinal vascular abnormalities (RVAs), including focal and generalized arteriolar narrowing. By this method, 56% of the 257 patients had RVAs, which was validated by masked interpretation of the photographs by neuro-ophthalmologists. The final diagnosis of stroke (27%) or TIA (73%) was based on a neurologist's review; stroke diagnosis required a positive DWI finding. Presence of focal or generalized arteriolar narrowing had high specificity (0.86) for TIA and stroke but relatively low sensitivity (0.31) and added independent information to the stroke and TIA predictive ability of the ABCD² score (a composite score with components of age, blood pressure, clinical features, duration of deficit, and presence or absence of diabetes).