Carotid dissection and carotid occlusion with stroke: neuro-ophthalmological manifestations

We assessed the prevalence and characteristics of neuro-ophthalmological manifestations (NOMs) in patients with stroke due to internal carotid artery (ICA) disease. NOMs were evaluated in 81 patients with ICA dissection and 229 patients with ICA atherosclerotic occlusion from the Lausanne Stroke Registry. NOMs, seen in 57% of patients with ICA dissection consisted of visual field defect (32%), Horner’s syndrome (26%), transient monocular blindness (5%), ocular ischaemic syndrome (4%) and ocular motor paresis (1%). The prevalence of NOMs was lower with ICA atherosclerotic occlusion (42%). Similarly, they consisted of visual field defects (26%), Horner’s syndrome (7%), transient monocular blindness (8%) and ocular ischaemic syndrome (3%). NOMs, consisting predominantly of homonymous hemianopia and transient monocular blindness, were the presenting signs in 16% of ICA dissection and 9% of ICA occlusion. Recognition of initial NOMs in these disorders may provide a window of opportunity for interventive therapies to avert stroke.