Central retinal artery occlusion (CRAO) can result in severe acute vision loss, and recent investigations have linked stroke complications temporally to this condition. Adding to the literature, new research from the Mayo Clinic found about 3% of patients suffered a stroke the same day or within 15 days after a CRAO diagnosis.

Of these, about 2.2% of study participants had ischemic strokes while 1.1% had hemorrhagic strokes. Additionally, 10% of subjects had transient monocular vision loss (TMVL) events.

Notably, the three stroke patients and two transient ischemic attack (TIA) patients in the study all had an embolic etiology of their CRAO, underscoring the prudence of evaluating for a nidus of embolic disease, the authors suggested.

The case series included the records of 89 patients with CRAO who were living in Olmsted County, MN, from 1976 to 2016. Investigators confirmed the new CRAO cases and recorded subsequent stroke, TIA and TMVL events in the 15 days before and after the ocular diagnosis. Patients were about 76 years old, roughly 56% were male and the majority were Caucasian (approximately 90%).

Starting in 1999, 15 out of 45 patients underwent MRI imaging within two months of their CRAO. One individual showed evidence of asymptomatic diffusion restriction, while nine subjects (60%) had a remote infarct.          

The study found an overall age and sex adjusted incidence of CRAO at 2.58 per 100,000 people. While CRAOs are considered uncommon, the peak incidence in the 80-to-89 age range was over eight times higher than the overall incidence, the authors noted. While the overall male and female incidence didn’t differ significantly, the number of CRAO cases in men jumped sharply in the 70-to-79 age bracket compared to a more gradual increase in women, they added.

The 2.2% risk of symptomatic ischemic stroke in the 15 days before and after a CRAO event was slightly lower than most studies from tertiary centers. Still, the findings should be considered as practice recommendations are developed regarding the urgency of neurovascular workup in patients with acute CRAO, the investigators suggested.

Chodnicki KD, Tanke LB, Pulidos JS, et al. Stroke risk before and after central retinal artery occlusion: a population-based analysis. Ophthalmology. July 22, 2021. [Epub ahead of print].