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A 37-year-old migrainous woman was referred several hours after a sudden dysarthria lasting less than 1 min. Brain MRI undertaken a few hours later showed no acute cerebral infarction on the diffusion-weighted imaging (DWI) sequence. However, an intraluminal thrombus within a distal branch of the middle cerebral artery (MCA) was seen on the T2*-weighted gradient echo images as well as hyperintense vessels related to slow flow beyond the occlusion's site. Control MRI 24 h later confirmed the presence of a small infarct affecting the distal portion of the MCA territory but the thrombus was no longer visible. A comprehensive etiologic workup revealed the presence of a patent foramen ovale, as the underlying cause of the patient's stroke. Though the sensitivity of DWI sequence for acute ischemia is high, false negative exist particularly in cases of transient ischemic attack, brainstem or lacunar strokes. A careful brain MRI examination or the use of perfusion weighted imaging sequences are useful to avoid misdiagnosis particularly in young patients. [ABSTRACT FROM AUTHOR]

To analyze the characteristics and the course of macular edema secondary to central retinal vein occlusion (CRVO) using optical coherence tomography (OCT) and to determine correlations between clinical, tomographic and angiographic data, in particular including retinal ischemia. In this retrospective study, 53 consecutive patients with CRVO were included. At each follow-up visit, patients underwent complete ophthalmological examination, including best-corrected visual acuity (BCVA) and OCT. Fluorescein angiography was performed at baseline and on demand during follow-up. 243 OCTs were analyzed. Mean age was 61 years and mean follow-up 13 months. The first structural change, observed very early after the onset of the occlusion, was a diffuse increase at the level of the outer nuclear layer without change at the level of the inner retina. This early change seemed characteristic of retinal vein occlusion. Cystoid spaces were subsequently observed in all retinal layers and were combined with serous retinal detachment in 51 %. During the first 6 months, central retinal thickness was higher in ischemic CRVO (mean, 691 μm) than in non-ischemic CRVO (mean, 440 μm, p < 0.01). In eyes with foveal thickness (central retinal thickness without subretinal fluid) of 700 μm or greater, peripheral ischemia was present in 69 % of eyes, final BCVA was 20/200 or less in 75 % and never reached 20/40 during follow-up. The integrity of the junction of the photoreceptors' inner and outer segments was correlated with a better prognosis ( p < 0.05). Foveal thickness was inversely correlated to BCVA at each visit and could have a prognostic value. OCT examination in CRVO revealed useful data for the diagnosis of CRVO and its prognosis. The largest macular edemas seemed to be the hallmark of ischemic CRVO. [ABSTRACT FROM AUTHOR]

The study was carried out to confirm the effect of calcium dobesilate (CaD) compared to placebo (PLA) on the blood-retinal barrier (BRB) permeability in early diabetic retinopathy (DR). Adults with type II diabetes and early diabetic retinopathy (below level 47 of ETDRS grading and PVPR between 20 and 50×10−6/min, plasma-free fluorescein) were included in this double-blind placebo-controlled study. Treatment was 2 g daily for 24 months. The primary parameter, posterior vitreous penetration ratio (PVPR), was measured every 6 months by fluorophotometry. Secondary parameters were fundus photography, fluorescein angiography and safety assessments. Metabolic control was performed every 3 months. A total of 194 patients started the treatment (98 CaD, 96 PLA) and 137 completed the 24-month study (69 CaD, 68 PLA). Both treatment groups were comparable at baseline, with ETDRS level 10 in about 59% of patients. Mean PVPR change from baseline after 24 months was significantly ( P=0.002) lower in the CaD group [−3.87 (SD 12.03)] than in the PLA group [+2.03 (SD 12.86)], corresponding to a 13.2% decrease in the CaD group and a 7.3% increase in the PLA group. PVPR evolution was also analysed by HbA1c classes (<7%, between 7 and 9%, ≥9%) and results confirmed the superiority of CaD independently of the diabetes control level. A highly significant difference [CaD: −3.38 (SD 13.44) versus PLA: +3.50 (SD 13.70)] was also obtained in a subgroup of patients without anti-hypertensive and/or lipid-lowering agents ( P=0.002 at 24 months). A further analysis of the secondary parameters showed significant changes in favour of CaD in the evolution from baseline to the last visit of haemorrhages ( P=0.029), DR level ( P=0.0006) and microaneurysms ( P=0.013). Regarding safety, only 2.5% ( n=5 patients/events) of all adverse events reported were assessed as possibly or probably related to the test drug, while all serious adverse events were reported as unlikely. There was no statistical difference between groups. Calcium dobesilate 2 g daily for 2 years shows a significantly better activity than placebo on prevention of BRB disruption, independently of diabetes control. Tolerance was very good. [ABSTRACT FROM AUTHOR]

Background: Hemorheologic abnormalities have recently been shown to play a role in the pathogenesis of retinal vein occlusion (RVO), and several studies have demonstrated the efficacy of isovolemic hemodilution in these eyes. This study was designed to investigate further the effects of hemodilution, with regard to the duration of symptoms before the treatment. Methods: In a prospective study, 142 eyes with central or hemicentral RVO were treated by isovolemic hemodilution. The target hematocrit value was 35%. Mean duration of follow-up was 10 months. A subgroup of 50 patients treated within 2 weeks of the onset of symptoms was compared first with patients treated later by hemodilution, and then retrospectively with controls with central RVO and without hemodilution. Results: Hemodilution therapy resulted in a decrease in hematocrit level from 42% to 32% on average, with no major side effect. After treatment, a significant decrease was observed in hemorheologic parameters (fibrinogen, erythrocyte aggregation), except in plasma viscosity. Retinal circulation times were significantly shortened. Visual acuity (VA) improvement immediately after treatment (in 43% of eyes) was correlated with better final visual outcome ( P<0.05). At the end of follow-up, VA was better in patients treated within the first 2 weeks than in those treated later and in controls (41% had VA of 20/40 or more in the early-treatment group versus 23% in the late-treatment group, P<0.01). Final retinal ischemia was also greater in the late-treatment group and in controls. Hemodilution in 12 patients with long-standing RVO and macular edema was ineffective. Conclusion: Our study is consistent with previous investigations that confirmed the efficacy of isovolemic hemodilution in RVO on hemorheologic parameters, retinal circulation times and final VA. It also underlined strongly the benefit of early treatment within the first 2 weeks of the RVO. Further studies are required to confirm these results. [ABSTRACT FROM AUTHOR]