Fundus Lesions Associated With Acute Lacunar Cerebral Infarction

ObjectiveLacunar infarction (LI) associated with cerebral small vessel disease is a common type ofclinical stroke, however, the exact pathological mechanism is remains unknown. more recently,it has been suggested that blood–brain barrier dysfunction or disordered small vesselendothelium may contribute. Fundus examination is the only window to directly observe thehuman small vascular . The retinal and cerebral small vessels are of similar size, and share acommon embryological, anatomical, physiological characteristics, besides, fundus photographyOperates easily. It has been suggested that the blood–retinal barrier is analogous to the blood–brain barrier, Retinopathy is associated with increased permeability of the blood–retinal barrier.Therefore, retinal vascular disease may provide clues of cerebral small vessel disease. Our studyattempts to observe and analyze retinopathy by fundus photography, investigate the correlationof acute infarction and rentinopathy, and determine whether it can serve as indicators to identifylacunar infarction.MethodsA total of 171 patients who admitted in the Department of Neurology, General Hospital ofBeijing Military Command and could perform fundus examination in a sitting position werecollected from Janunary 2011 to October 2011. The diagnostic criteria is from the standards seton the Fourth National Cerebrovascular Diseases Conference 1995.All patients had cerebral MRIto conform the diagnosis . They were divided into either a lacunar infarction group (n = 78) or anonlacunar infarction group (n = 93) according to the size of infarction area on cerebral MRIfindings by Professional neurologists. All patients had both eyes fundus photography, the trainedophthalmologist being blinded to clinical details assessed the rentinopathy (Arteriovenouscrossing signs, microaneurysms, hard exudates, cotton wool spots, and bloodspots), and thegeneral clinical data and retinopathy were compared in the patients of both groups.Results①The incidences of hypertension, atrial fibrillation and lacunar infarction history as well asplasma Creactive protein level in the lacunar infarction group were higher than those in thenolacunar infarction group. The differences were statistically significant (P <0.05 or P <0. 01) .②The incidence of arteriovenous crossing signs was 73. 1% (57/78) and that of the hardexudates was 30. 8% (24/78) in the lacunar infarction group. They were higher than 58. 1% and16. 1% in the nonlacunar infarction group (P <0. 05). There were no significant differences inother retinopathies.③Logistic regression analysis showed that the incidence of lacunar infarction of patients with arteriovenous crossing signs was 1. 96 times of those without arterial crossing signs (OR =1.96,95% CI: 1. 03 -3. 75) The incidence of lacunar infarction of patients with hard exudates was2. 31 times of those without hard exudates (OR = 2. 31,95% CI: 1. 11 - 4. 81).④The Multivariate the logistic regression analysis showed that hypertension, heart disease,previous lacunar infarction history were the independent factors for retinopathy (OR = 4. 22,95%CI: 1. 90 - 9. 36; OR = 2. 33,95% CI: 1. 08 - 5. 02; OR = 37,95% CI:1. 30 -4.33).ConclusionThe arteriovenous crossing signs and hard exudates in fundus lesions were correlated withlacunar infarction. Different retinopathy can suggest different causes of lacunar infarction.