Journal of Ophthalmology (Jun 2019)
Neurological and ocular manifestations of chronic cerebral ischemia
Abstract
Purpose: To analyze neurological, neuropsychological, and ocular manifestations and their correlations in patients with chronic cerebral ischemia (CCI). Materials and Methods: One hundred and twenty patients (67 women and 53 men) with signs of mild or moderate CCI were involved in the study. They underwent clinical-and-neurologic, neuropsychologic and ocular examination, and assessment with a number of paraclinical diagnostic techniques (magnetic resonance imaging (MRI) of the brain, transcranial Doppler ultrasonography (TDS) of the major head and neck vessels, and electroencephalography. Results and Discussion: Neurological examination revealed signs of vestibulo-cerebellar, pyramidal and extrapyramidal syndromes, thereby evidencing moderate CCI. Neuropsychological tests found mild cognitive impairment syndrome in 21.5% of patients younger than 60 years. Patients with mild CCI demonstrated no significant visual impairments, but changes in electrophysiological parameters. Patients with moderate CCI demonstrated signs of chronic optic neuropathy, which was found in 71 (61.7%) cases. Non-specific results of paraclinical investigations of patients with CCI should be interpreted comprehensively. They revealed diffuse neurological symptoms of microangiopathic origin. Ocular symptoms and changes on MRI brain scans and TDS of the major head and neck vessels indicated abnormalities in the vertebrobasilar region. Conclusion: The signs of chronically impaired blood flow to the brain revealed both by clinical-and-neurologic and neuropsychologic examination, and evaluation with paraclinical diagnostic techniques may account for ocular syndromes and their severity. Visual abnormalities and changes in the electrophysiological characteristics of the visual system, in their turn, are potential predictors of chronic cerebral ischemia.
Keywords
